Treatment of tuberculosis

Antibiotic therapy since the discovery and introduction into clinical practice in late 1943, streptomycin firmly took the leading place in the treatment of tuberculosis. For 40 years of antibacterial therapy, the arsenal of tuberculostatic drugs has been replenished with many highly active antibiotics and chemotherapeutic agents. This allows to apply their various combinations taking into account the form and severity of the disease, the age of the patient, the stage of treatment and the tolerability of drugs, which greatly expands the possibilities of antibacterial therapy of tuberculosis.

When carrying out therapy for children with tuberculosis with various localizations, it is important to use a full range of therapeutic measures, including chemotherapeutic, pathogenetic, surgical and rehabilitative methods of influencing the child's organism. Antibiotic therapy, which serves as the main method for treating tuberculosis patients, should be conducted against the background of a well-organized sanitary and dietary regime. It is customary to start treatment of active forms of local tuberculosis under stationary conditions, where it is possible to use various types of symptomatic, pathogenetic therapy along with the organization of a proper regimen and specific treatment, to identify the tolerability of antituberculosis drugs, to prevent or eliminate the side effect of them, to monitor the dynamics and features of the course of the tuberculosis process every patient. In the formation of pronounced residual changes after the transferred primary tuberculosis, surgical treatment is possible. It is necessary to observe the phasing of antibacterial therapy.

• The first stage of treatment is the phase of intensive therapy, it is usually performed in a hospital.
• The second stage of treatment is the continuation phase of therapy, it is performed in a sanatorium or outpatient setting.

Patients with small and uncomplicated forms of tuberculosis can be treated immediately on an outpatient basis or in specialized sanatoria. The place of the second stage of treatment is determined individually - depending on the age of the child, the prevalence of the process and the social status of the parents. In this case, the use of standard antibiotic therapy (treatment protocols) with direct treatment control is necessary.

Treatment regimes for tuberculosis in children and adolescents

The chemotherapy regimen - a combination of antituberculosis drugs, the duration of their admission, the timing and content of control examinations, and the organizational forms of treatment - are determined depending on the group to which the tuberculosis patient is related. This should be guided by the instructions approved by the Ministry of Health of Russia on the use of specific drugs.

In the process of chemotherapy, direct monitoring of medical personnel for taking antituberculous drugs is important. It is necessary constant cooperation between the patient and medical personnel, the formation of a responsible attitude to the treatment of the adult patient and the parents of the child.

Anti-TB drugs

Antituberculous drugs are divided into main (first row) and back-up (second row).

• The main drugs are isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin. They are prescribed as separate or combined dosage forms.
• Reserve preparations - protionamid (ethionamide), kanamycin, amikacin, capreomycin, cycloserine, rifabutin, aminosalicylic acid, lomefloxacin, ofloxacin.

Reserve drugs are used under the supervision of an anti-tuberculosis institution in which centralized quality control of microbiological diagnosis and treatment of tuberculosis is carried out.

All antituberculosis drugs are divided into synthetic chemotherapy drugs and antibiotics. Anti-tuberculosis drugs are mainly bacteriostatic, that is, they inhibit the growth and reproduction of MW. However, isoniazid, rifampicin and streptomycin also have a bactericidal effect. In general, it depends on the mechanism of their influence on MW and concentration in the affected area.

The drugs are studied in detail in the experiment and in the clinic. When appointing each of them take into account its effect on the MBT, the bacteriostatic activity of the blood and the peculiarities of the influence on the patient's body. In recent years, there have appeared combined antituberculosis drugs (Rifater, Rifanak, etc.). However, in the treatment of children with tuberculosis, their use is not justified because of the difficulty in choosing the dose during treatment. The most expedient is their use in the treatment of latent tuberculosis infection in outpatient settings.

Treatment of tuberculosis in children must be carried out taking into account the anatomical and physiological, psychological features of the child's body, as well as the form, prevalence of the tuberculosis process, the degree of its expression and activity. Treatment of active forms of local tuberculosis should begin in a stationary environment, where it is possible to use different types of symptomatic, pathogenetic therapy along with the organization of a proper regimen and specific treatment, to identify the tolerability of antituberculosis drugs, to prevent or eliminate their side effects, to track the dynamics and features of the course of the tuberculosis process each patient.

Antibiotic therapy, which serves as the main method of treatment for tuberculosis patients, is conducted against the backdrop of a well-organized sanatorium-diet regime. They begin it immediately after diagnosis and are carried out continuously and for a long time by applying various combinations of antibacterial drugs. In the formation of pronounced residual changes in the form of tuberculosis, large calcified lymph nodes after 6-8 months of use of therapeutic agents raise the issue of surgical intervention. Continuous treatment of tuberculosis is carried out until a significant improvement is achieved in terms determined by a clinical-radiological assessment of the course of the process. When identifying the limited and uncomplicated (small) forms of tuberculosis in children from the outset, treatment can be conducted in a sanatorium. The described technique is simple, it is easy to use not only in children's tubercular hospitals, but also in sanatoriums. The course of tuberculosis in the newly diagnosed small forms of tuberculosis of respiratory organs in children and adolescents is mostly smooth, accelerated, without exacerbation, wave-like course with small forms of tuberculosis occurs when treatment of the newly detected process is carried out irregularly and underreported doses of drugs.