Preventive treatment of tuberculosis

Preventive treatment of tuberculosis in order to prevent tuberculosis is prescribed by a phthisiopediatrician. This section of work should be a priority in the work of the phthisiopediatric service. Preventive treatment is carried out for children and adolescents infected with MBT for the first time (virage, early period of latent tuberculosis infection), as well as from high-risk groups for tuberculosis.

If a turn is established, the child is referred to a phthisiatrician who monitors the patient for 1 year. After the early period of primary tuberculosis infection, the child remains infected with MBT (in the absence of risk factors for tuberculosis, provided that timely chemoprophylaxis is carried out) or local tuberculosis develops at various times after the primary infection (depending on the massiveness, virulence of MBT and the state of the macroorganism).

Preventive treatment is organized in a differentiated manner depending on the risk factors for the disease. In the presence of specific risk factors (absence of BCG, contact with a patient with tuberculosis), preventive treatment is necessarily carried out in a hospital or sanatorium; in other cases, the volume and location of preventive treatment are determined individually.

• Primary prevention of tuberculosis - conducting preventive treatment of uninfected children and adolescents who have had contact with a patient with tuberculosis (IV group of dispensary registration with a phthisiatrician).
• Secondary prevention of tuberculosis - conducting preventive treatment of infected children and adolescents based on the results of mass tuberculin diagnostics (Group VI of dispensary registration with a phthisiatrician).

Indications for the appointment of prophylactic treatment with antibacterial drugs

The following indications for the prescription of prophylactic treatment with antibacterial drugs have been identified.

• Children and adolescents infected with tuberculosis:
  • in the early period of primary tuberculosis infection (conversion of tuberculin tests) without local changes;
  • in the early period of primary tuberculosis infection (conversion of tuberculin tests) with a hyperergic reaction to tuberculin;
  • with increasing sensitivity to tuberculin;
  • with hyperergic sensitivity to tuberculin;
  • with monotonous sensitivity to tuberculin in combination with risk factors for tuberculosis.
• Children and adolescents who have been in contact with people with tuberculosis.

The approach to preventive treatment of children at risk for tuberculosis should be individualized, taking into account epidemiological and social risk factors.

It is important to remember that chemoprophylaxis with one anti-tuberculosis drug (isoniazid or ftivazid, or metazid in age-appropriate dosages) in outpatient settings can be administered to children from groups IV, VI-A, VI-B only if they have no additional (specific or non-specific) risk factors for the development of the disease. Contact with a patient with tuberculosis in an infected child and the presence of other risk factors are the most threatening indicators that contribute to the development of tuberculosis. Preventive therapy for such children should be administered with two anti-tuberculosis drugs in specialized children's institutions. If the observed patients have allergic diseases, preventive treatment is administered against the background of desensitizing therapy.

Chemoprophylaxis is prescribed to children for 3 months; preventive treatment is carried out individually, depending on risk factors, from 3 to 6 months.

The effectiveness of chemoprophylaxis (preventive treatment) is monitored using clinical and laboratory indicators and tuberculin diagnostics. A decrease in sensitivity to tuberculin, satisfactory clinical and laboratory indicators, and the absence of the disease indicate the effectiveness of the preventive measures taken. A further increase in sensitivity to tuberculin or negative dynamics of clinical and laboratory indicators is an indication for a more thorough examination of the child for tuberculosis.

When monitoring a child at risk for tuberculosis in anti-tuberculosis dispensaries, it is important to remember that the course of tuberculosis infection, as well as long-term treatment of children with anti-tuberculosis drugs, contributes to a decrease in the body's defenses and leads to an increase in somatic morbidity. It is possible to increase the body's resistance and reduce the risk of tuberculosis by creating specific immunity against the most common non-specific diseases at this age.

This goal is achieved in the following way: during preventive chemotherapy with anti-tuberculosis antibacterial drugs, local immunostimulants are introduced into the child’s body and seasonal vaccination against influenza and pneumococcal infection is carried out in a group of frequently ill children or in the presence of other non-specific risk factors.

Phthisiologists and general pediatricians must remember that other preventive vaccinations are prohibited during treatment of latent tuberculosis infection!

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