Treatment of tuberculosis

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

When treating children with tuberculosis of various localizations, it is important to use a full range of therapeutic measures, including chemotherapeutic, pathogenetic, surgical and rehabilitation methods of influencing the child's body. Antibacterial therapy, which is the main method of treating patients with tuberculosis, should be carried out against the background of a well-organized sanitary and dietary regimen. Treatment of active forms of local tuberculosis is usually started in hospital conditions, where it is possible, along with organizing the correct regimen and conducting specific treatment, to use various types of symptomatic, pathogenetic therapy, to identify the tolerance of anti-tuberculosis drugs, to prevent or eliminate their side effects, to track the dynamics and features of the tuberculosis process in each patient. In the formation of pronounced residual changes after primary tuberculosis, surgical treatment is possible. It is necessary to adhere to the stages of antibacterial therapy.

• The first stage of treatment is the intensive care phase, which is usually carried out in a hospital setting.
• The second stage of treatment is the continuation phase of therapy, which is carried out in a sanatorium or on an outpatient basis.

Patients with minor and uncomplicated forms of tuberculosis can be treated immediately on an outpatient basis or in specialized sanatoriums. The location 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, it is necessary to use standard antibacterial therapy regimens (treatment protocols) with direct treatment control.

Treatment regimens for children and adolescents with tuberculosis

The chemotherapy regimen - a combination of anti-tuberculosis drugs, the duration of their administration, the timing and content of control examinations, as well as the organizational forms of treatment - is determined depending on the group to which the tuberculosis patient belongs. In this case, one should be guided by the instructions for the use of specific drugs approved by the Russian Ministry of Health.

During chemotherapy, direct control of medical personnel over the intake of anti-tuberculosis drugs is important. Constant cooperation between the patient and medical personnel is necessary, as well as the formation of a responsible attitude towards treatment on the part of the adult patient and the child's parents.

Anti-tuberculosis drugs

Anti-tuberculosis drugs are divided into primary (first line) and reserve (second line).

• The main drugs are isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin. They are prescribed in the form of separate or combined dosage forms.
• Reserve drugs: prothionamide (ethionamide), kanamycin, amikacin, capreomycin, cycloserine, rifabutin, aminosalicylic acid, lomefloxacin, ofloxacin.

Reserve drugs are used under the supervision of an anti-tuberculosis institution, which carries out centralized quality control of microbiological diagnostics and treatment of tuberculosis.

All anti-tuberculosis drugs are divided into synthetic chemotherapeutic agents and antibiotics. Anti-tuberculosis drugs act mainly bacteriostatically, that is, they inhibit the growth and reproduction of MBT. However, isoniazid, rifampicin and streptomycin also have a bactericidal effect. It mainly depends on the mechanism of their influence on MBT and the concentration in the affected area.

The drugs have been thoroughly studied in experiments and clinically. When prescribing each of them, their effect on MBT, bacteriostatic activity of blood and the specific effects on the patient's body are taken into account. In recent years, combined anti-tuberculosis drugs have appeared (Rifater, Rifanak, etc.). However, their use is not justified in the treatment of children with tuberculosis due to the complexity of choosing a dose during treatment. Their use is most appropriate in the treatment of latent tuberculosis infection in outpatient settings.

Treatment of tuberculosis in children should be carried out taking into account the anatomical, physiological, psychological characteristics of the child's body, as well as the form, prevalence of the tuberculosis process, the degree of its severity and activity. Treatment of active forms of local tuberculosis should be started in hospital conditions, where it is possible, along with the organization of the correct regimen and the implementation of specific treatment, to use various types of symptomatic, pathogenetic therapy, to identify the tolerance of anti-tuberculosis drugs, to prevent or eliminate their side effects, to track the dynamics and features of the course of the tuberculosis process of each patient.

Antibacterial therapy, which is the main method of treating patients with tuberculosis, is carried out against the background of a well-organized sanatorium-dietary regimen. It is started immediately after the diagnosis is established and is carried out continuously and for a long time by using various combinations of antibacterial drugs. When significant residual changes in the form of tuberculomas, large calcified lymph nodes are formed after 6-8 months of using therapeutic agents, the question of surgical intervention is raised. A continuous course of tuberculosis treatment is carried out until significant improvement is achieved within the timeframe determined by the clinical and radiological assessment of the course of the process. When limited and uncomplicated (minor) forms of tuberculosis are detected in children, treatment can be carried out in a sanatorium from the very beginning. The described technique is simple, it is easy to use not only in children's tuberculosis hospitals, but also in sanatoriums. The course of tuberculosis in newly diagnosed minor forms of tuberculosis of the respiratory organs in children and adolescents is generally smooth, accelerated, without exacerbations; a wave-like course in minor forms of tuberculosis occurs in cases where treatment of the newly diagnosed process is carried out irregularly and with reduced doses of drugs.