Drugs in the treatment of pulmonary tuberculosis. What pills do they drink for tuberculosis and their names. How many live with HIV and tuberculosis together

According to statistics, tuberculosis is one of the ten leading causes of death worldwide... Globally, the global tuberculosis eradication strategy is gradually decreasing (by about two percent per year) thanks to the WHO End TB Strategy. And yet, tuberculosis continues to be the most difficult and significant social and medical problem.

The death rate from tuberculosis is about 1.7 million per year.

Before the discovery of antibiotics, tuberculosis was considered an absolutely incurable disease. At the moment, many highly effective treatment regimens for this disease have been developed, but multidrug-resistant forms of tuberculosis pose significant difficulties for treatment.

Due to the rapid increase in the resistance of mycobacterium tuberculosis to antibacterial drugs, all treatment should be prescribed exclusively by a phthisiatrician, after a full examination and obtaining crops for the sensitivity of the pathogen to drugs. It is strictly forbidden to independently adjust treatment, dosages, regimens and frequency of administration, as well as to stop treatment ahead of time.

Treatment of tuberculosis at home with folk remedies is unacceptable. Herbs, infusions, a method popular on the Internet - a dried bear from pulmonary tuberculosis are not effective and cannot replace a full-fledged complex anti-tuberculosis therapy.

It must be understood that folk remedies for pulmonary tuberculosis in adults and children can only be used as an addition to the treatment prescribed by the phthisiatrician for general strengthening purposes. All folk recipes and herbs for tuberculosis can be used after consulting a phthisiatrician.

Tuberculosis is a curable disease, but a number of factors need to be considered. Mycobacterium tuberculosis is a widespread bacteria and is distinguished by a high level of vitality and the ability to adapt to various environmental factors. In some cases, Koch's bacillus can go from an active state to a "dormant" state, thus becoming invulnerable to antibiotics.

Also, the bacterium is able to quickly develop resistance to the drugs used.

In particular, a high risk of developing multidrug-resistant tuberculosis (resistant to most or all known anti-tuberculosis drugs) is observed in patients with HIV and in those who miss the timely intake of prescribed drugs, stop treatment ahead of schedule, etc.

It is necessary to understand that for a complete cure of tuberculosis, a long time and regular medication are required. Early withdrawal of therapy (with stabilization of the patient's well-being) can cause reactivation of the infection and the development of resistance to the drugs used.

At the same time, if a patient has open tuberculosis, he can infect others with a multi-resistant disease (first of all, the patient's relatives are at risk).

The medicine for tuberculosis is selected by a phthisiatrician in a hospital. As a rule, complex treatment is prescribed, including four to five remedies. The duration of treatment and the selected regimens are strictly individual.

How many live with tuberculosis in an open form

With timely admission to the hospital, good sensitivity of mycobacteria and the absence of concomitant pathologies that aggravate the severity of the patient's condition, the disease is curable.

Inpatient tuberculosis treatment

Open tuberculosis is highly contagious. In this regard, all treatment is carried out in the conditions of an anti-tuberculosis dispensary. The duration of the transfer of an open form to a closed one is individual and can be from two to four or more months.

The duration of further treatment is also individual.

Patients with closed forms of tuberculosis can be treated at home. In the future, the patients are prescribed supportive and spa treatment.

Disability with pulmonary tuberculosis

In most cases, the issue of disability registration for tuberculosis is considered if the treatment takes more than ten months. The decision to assign a group is made on the basis of the results of a medical and social examination. The disability group assigned to the patient depends on the severity of the disease and the degree of impairment of the body's functions.

The main indications for referral to the ITU (medical and social expertise) are:

the duration of treatment is more than 10-12 months;
the appearance of completely or partially irreversible disorders of the body's functions, leading to the fact that the patient needs a change in working conditions;
severe course of the disease, accompanied by disability and / or the need for outside help (loss of the ability to self-service);
the need for the next re-examination, changing the previously established cause of disability, changing the previously assigned group, receiving recommendations regarding further employment.

According to the results of the medical commission, the patient is assigned the status of temporary disability or a group of disability corresponding to the severity of his condition. The assignment of social and labor pensions to patients with tuberculosis is carried out in accordance with the group of disability received.

As benefits, patients are entitled to:

registration of sick leave for a period of nine to twelve months, with guaranteed preservation of the workplace;
registration of social insurance benefits;
provision of free medicines from a special list of anti-tuberculosis drugs;
free spa treatment.

Where can you work after tuberculosis

The admission to work after suffering tuberculosis is issued by the VKK (medical consulting commission). Admission to continue studies or return to work is issued subject to:

complete completion of the course of anti-tuberculosis treatment;
absence of symptoms of the disease;
laboratory confirmed absence of bacterial excretion (threefold analysis and intervals of two to three months);
absence of signs of reactivation of pathological processes.

Patients after tuberculosis are strictly prohibited from working in the following areas:

health care (hospitals, pharmacies, laboratories, etc.);
catering;
education and preschool childcare facilities (kindergartens, schools, institutes, etc.);
trade.

Also, patients after tuberculosis are contraindicated in hard physical work, work involving contact with dust, chemicals, coal dust, hot air (work in workshops), night shifts, etc.

Patients after tuberculosis are allowed to work as accountants, extras, programmers, economists, work at home or in workshops at a tuberculosis dispensary, repair shops, etc.

Treatment of pulmonary tuberculosis in adults

To achieve maximum effectiveness, therapy should be timely, combined, strictly controlled and regular (skipping medication is unacceptable), long-term and sufficiently intense, step-by-step, and also prescribed taking into account the sensitivity of mycobacteria to the antibacterial drugs used.

Anti-TB drugs (anti-TB drugs) are usually divided into three groups:

class A drugs (the most effective drugs) - isoniazid drugs (isoniazid tablets for tuberculosis are among the most effective and often prescribed drugs) and rifampicin;
class B drugs (moderately effective drugs) - preparations of streptomycin, ethambutol, pyrazinamide, ethionamide, kanamycin, cycloserine, viomycin;
class C drugs (low-effective drugs).

The main drugs used in classic regimens are isoniazid (H), rifampicin (R), ethambutol (E), streptomycin (S), pyrazinamide (Z).

The second-line backup means include drugs of thioacetozone (T), prothionamide (Pt), ethionamide (Et), kanamycin (K), amikacin (A), capreomycin (Cap), cycloserine (Cs), rifabutin (Rb), PASKa (PAS), fluoroquinolones (Fq), amikacin (Am), etc.

The classic scheme for tuberculosis is the appointment of isoniazid, rifampicin, pyrazinamide, ethambutamol and streptomycin (H, R, Z, E, S). In this case, streptomycin is used in a course of no more than two months. RHZE or RHZ combinations can also be assigned. For maintenance courses, a combination of rifampicin and isoniazid is prescribed.

For convenience, combined means are often used:

Rifater (isoniazid, rifampicin, and pyrazinamide);
rifampicin, isoniazid and ethambutamol and other drugs.

Treatment of tuberculosis in children

Treatment of tuberculosis in children is carried out according to similar schemes (usually HRZE). Dosages are calculated depending on the patient's weight.

In addition to chemotherapy of tuberculosis, collapsotherapy (creation of artificial pneumothorax and pneumoperitoneum), thoracoplasty, therapeutic fibrobronchoscopy, physiotherapy exercises, breathing exercises can be used to treat children and adults (for tuberculosis, respiratory gymnastics according to Bolotov, etc.) can be used.

Surgery for pulmonary tuberculosis

Surgery is used as an adjunct to chemotherapy. For the treatment of tuberculosis can be used:

thoracoplasty (rib removal);
pneumolysis (creation of an artificial cavity with a gas bubble, but rarely used today);
surgical interventions on peripheral nerves, in order to change blood circulation and lymph circulation in the lungs;
resection of the affected lungs;
decortication and pleuroectomy;
cavernotomy;
operations to stop pulmonary bleeding.

Treatment of tuberculosis after surgery is continued according to previously prescribed chemotherapy regimens.

Treatment of tuberculosis with folk remedies - the most effective schemes

Patients often ask a phthisiatrician if it is possible to put mustard plasters for tuberculosis, use herbs and can they replace drug treatment? Not. All treatment should be comprehensive, long-term and individual. Tuberculosis cannot be cured without antibiotics.

Despite the fact that long-term antibiotic therapy is fraught with various complications, in this case, it is a justified risk. Early drug withdrawal can lead to the development of a completely drug-resistant form of the disease.

No folk remedies can cure tuberculosis. The use of honey with aloe, fish, badger, bear fats, herbal tinctures, etc. are not pathogenetic therapy for tuberculosis. All these funds can only be considered as a general strengthening addition to the antibiotic treatment regimen prescribed by the doctor.

Consequences of tuberculosis

The consequences of the disease are divided into complications of tuberculosis during the active phase of the disease and the consequences of long-term treatment with anti-tuberculosis drugs, as well as surgery (thoracoplasty for tuberculosis is used in severe disease, as an adjunct to chemotherapy).

Complications of pulmonary tuberculosis can be:

the development of cardiopulmonary failure;
the appearance of hemoptysis or pulmonary bleeding;
development of spontaneous pneumothorax;
the formation of tuberculous pleurisy, pleural empyema, atelectasis, etc.;
accession of extrapulmonary forms of tuberculosis (tuberculous meningitis, lesions of mesenteric lymph nodes, etc.)
disability as a result of residual changes in the lungs (fibrous, fibrous-focal, bullous-dystrophic, cirrhotic, pleuropneumosclerotic, etc.), as well as due to impaired respiratory function after surgical treatment (removal of a part of the lung, etc.);
development of secondary tuberculosis, etc.

It should also be noted that since pathogenetic therapy for tuberculosis can

take more than a year (the duration of treatment depends on the severity of the disease and the sensitivity of mycobacterium tuberculosis to antibiotics), patients often experience various side effects from long-term and intensive antimicrobial therapy:

allergic reactions;
dysfunctions of the liver and kidneys;
jaundice;
disorders of the gastrointestinal tract;
heart rhythm disturbances;
accession of fungal infections;
problems with conceiving and bearing a child;
pain in muscles and joints;
headaches, dizziness;
noise in ears;
severe dysbiosis;
weakness;
steady rise in temperature;
anxiety, insomnia, depressive disorders;
changes in the hemogram (leukocytopenia, neutropenia, thrombocytopenia);
blood clotting disorder, etc.

To reduce the risk of side effects, all antibiotics for tuberculosis should be taken under the control of laboratory indicators of liver, kidney, blood clotting, etc.

Tuberculosis and HIV infection

HIV infection and tuberculosis have a mutually reinforcing influence on each other. It should be noted that it was the HIV epidemic at the end of the last century that became the main reason for the rapid increase in the incidence of tuberculosis throughout the world.

Currently, HIV remains the leading risk factor for the development of tuberculosis in adults and children. According to statistics, the most common infection leading to death of HIV patients is tuberculosis.

Moreover, there are two options for combining these infections:

the addition of tuberculosis in patients with HIV or acquired immunodeficiency syndrome (AIDS);
the addition of HIV or AIDS in patients with active tuberculosis or exacerbation of the process after the end of treatment.

The high incidence of tuberculosis in HIV patients allows us to conclude that when the immune system is damaged by the human immunodeficiency virus, the latent post-tuberculosis infection is reactivated, which was previously present in the patient, but restrained by his own immunity.

Due to the defeat of the HIV immune system, as well as the violation of the differentiation of macrophage cells and the formation of specific granulation tissues, specific tuberculous granulomas may not form in patients with tuberculosis in the late stages of HIV.

The severity of tuberculosis directly depends on the stage of HIV. The fewer CD4 cells in the patient's blood, the faster and more severe the damage to the lungs.

A feature of the development of tuberculosis in patients with AIDS can be considered its malignant and fulminant development, the rapid progression of lung decay in tuberculosis, a tendency to severe necrotic reactions, as well as the frequent addition of extrapulmonary forms of tuberculosis (tuberculous meningitis, lesions of mesenteric lymph nodes, etc.) and ineffectiveness or ineffectiveness of the prescribed anti-tuberculosis treatment.

How many live with HIV and TB together?

With the addition of tuberculosis sensitive to antibiotic therapy in the early stages of HIV, subject to adequate antiretroviral and anti-tuberculosis treatment, patients can live for 10, 20 or more years (the terms are individual).

For multi-resistant forms of tuberculosis or the addition of tuberculosis already in the late stages of AIDS (tuberculosis in the decay stage in such patients is characterized by a fulminant malignant course), as well as if the prescribed drug regimens are not followed, the prognosis is poor (less than a year).

Article prepared
infectious disease doctor Chernenko A.L.

Tuberculosis infection is one of the most common pathologies in the world. Among the huge number of infectious diseases, it continues to lead in the number of deaths.

Timely diagnostics to identify a dangerous infection allows you to provide patients with qualified assistance in time, to stop the infection of others and restore health to patients. Today, innovative diagnostic methods of tuberculosis allow it.

Contact of a patient with a doctor, with signs of suspected tuberculosis infection, begins with taking an anamnesis about the development of the disease, physical diagnosis and mandatory clarification of the diagnosis of tuberculosis, differentiating it from other infectious diseases that are similar in clinical signs, which is a difficult task.

Bacteriological examination

Bacterial analysis of the material is used when a disease is suspected. Bacteriological research techniques include:

direct bacterioscopy;
culture study of sowing;
VASTES;
PCR test.

For bacterial research, various materials can be used: pleural, cerebrospinal, joint-cavity or abdominal fluid, urine, wound and fistulous ichor, menstrual blood or tissue biopsy, scraping materials and cerebrospinal fluid and cerebral fluid.

In children, gastric lavage fluid is taken for analysis, because babies do not expectorate sputum, but swallow it. When tuberculosis is detected in children, the diagnosis is carried out (by the only early method) using the tubirculin test "Pirke".

PCR test in the diagnosis of tuberculosis infection is the most promising bacterioscopic method, which allows, due to its special increased sensitivity, to identify the DNA of the pathogen within one day.

Other diagnostic methods include:

Various techniques of bronchoscopy, with and without anesthesia. It is used for diagnostic examination of the respiratory system and biopsy.
Spirometry, which allows to assess the function of ventilation of lung tissues, the type and degree of disorders.
Transthoracic needle biopsy.
Radiological diagnostic techniques - modifications of CT, fluorographic examination and radiography. Allowing, together with microbiological analysis, to quickly diagnose infiltrative tuberculosis.
Diagnostic open surgery - lymph node biopsy or thoracotomy with biopsy of the lung and pleural tissue (the chest cavity is opened).
Endoscopic examination techniques - mediastinoscopic and pleuroscopy.

Using the methods of modern diagnostics of tuberculosis pathology, the localization of the infection and the severity of the disease are identified in the shortest possible time - this allows the doctor to draw up an adequate treatment protocol in time.

Tuberculosis treatment, drugs and regimens

The treatment protocol of tuberculosis is based on the maximum suppression of the spread of infection and the rapid restoration of damage caused by the action of the office. Treatments for effective treatment of tuberculosis include:

Timely use of antimicrobial therapy, which will accelerate the relief of mycobacterial excretion in the patient, already at the initial stage of the therapeutic process and will allow the restoration of organic lesions, minimizing the risk of complications.
Treatment until the body is completely stabilized.
Complex therapy, taking into account the age characteristics of the patient and background diseases, using: pathogenetic, symptomatic, physiotherapeutic and surgical treatment methods.
Regular intake of anti-tuberculosis drugs. That will eliminate drug resistance of the infection, because even a short interruption of the treatment course of tuberculosis leads to its development.

Anti-tuberculosis drugs

In the arsenal of modern medicine there are more than a dozen groups of anti-tuberculosis drugs and an impressive set of surgical techniques.

The main stage of treatment begins with the appointment of drugs that suppress the active reproduction of the pathogen. In the initial period of the disease, the localization of most MBT is outside the cell. At this time, until complete abazzillation, treatment should take place in a hospital.

When the process of bacterial growth slows down, and many MBT are inside the cell, other medications are indicated. Aftercare at home is allowed. It should be noted right away that the treatment of tuberculosis at home using folk remedies must be coordinated with a doctor in order to eliminate all risks.

Drugs for the treatment of tuberculosis are divided into groups - main and reserve.

The main group of drugs is characterized by the highest possible efficacy and minimal toxicity. The group of basic drugs includes drugs and their analogues - "Rifampicin", "Pyrazinamide", "Ethambutol", "Isoniazid", "Streptomycin"

In the treatment of tuberculosis in children, specially developed schemes of anti-tuberculosis drugs are used, consisting of a complex course of "Ftivazid", "Ginka", "Tubazida", "Pasca" and others.

Reserve drugs are indicated if the patient does not tolerate essential drugs well or if they are not effective enough. The group of reserve anti-TB drugs includes: "Kanamycin", "Ciprofloxacin", "Capreomycin", "Rifabutin", "Ofloxacin", "Thioacetazone", "Amikacin", or series "Ethionamide", "Cycloserine", "Protionamide".

For the convenience of using therapeutic agents and reducing the amount of daily intake, from the main group of anti-TB drugs, combined drugs have been developed - two component drugs (Rifinag, Phtizoetam, Phtizopyram), three (Rifacomb, Rifater, Mairin) and 4-component (Mairin P).

Surgical treatment of tuberculosis

Surgical methods of tuberculosis treatment are used in cases where conservative therapy has not yielded results and the destructive activity of the infection threatens the patient's life.

Surgical techniques are different, their choice depends on the extent, degree of organ damage, its functionality and the infectious phase of the disease. Usually, these are patients with pulmonary disease.

The most popular surgical techniques include:

cutting off the affected part of the organ by resection;
sectional removal of lung tissue;
resection of the entire lung;
excision of cavernous zones;
reconstructive surgery to remove a thickened pleural membrane (pleurectomy).

Pathogenetic therapy

Physiotherapy techniques are the basis of anti-tuberculosis treatment. Their task is to strengthen and consolidate the action of antibacterial drugs. At the initial stage of the disease, when inflammatory, exudative and necrotic processes are observed that destroy the tissue structure of the lung, the following are prescribed:

electrophoresis procedures,
ultrasound sessions;
drug inhalations;
high-frequency, microwave and laser therapy.

1) Ultrasound therapy is prescribed for damage to lung tissue with tuberculomas and cavernous cavities. Its effect relieves pain and relieves inflammation, loosens encapsulated tuberculomas and sealed cavernous walls, providing drug access to foci of damaged tissues.

2) The effect of magnetotherapy is due to the effective resorption of inflammatory exudation and the stimulation of tissue regeneration. Promotes
acceleration of healing and scarring of fistulas and cavities. The procedure is prescribed after an effective medication course, after 3 months.

3) To activate reparative (restorative) tissue regeneration, laser therapy is used, the action of which is aimed at improving and stabilizing blood circulation in damaged foci. It is prescribed a month after drug therapy and as a preparatory procedure before surgery.

4) Microwave sessions promote tissue regeneration and reduce dystrophic changes during the period of decreasing infectious aggression. This technique is able to prevent the formation of tissues compacted with fibrosis, adhesive and cicatricial processes.

An important link in tuberculosis therapy is the restoration of the patient's immunity, since the infection disrupts all links of the body's immune system.

Effective detoxicants and antioxidants are preparations of the group of membrane stabilizers - "Polyoxidonium", "" and "Glutoxim", which contribute to the restoration of phagocytic immune defense.

The process of curing a tuberculosis infection is long, requiring special patience from the patient. A correctly drawn up treatment protocol and self-discipline of the patient, which excludes interruption of taking anti-TB drugs, contributes to a significant acceleration of the healing process.

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Tuberculosis remains the second leading cause of death from infectious diseases among the adult population.

One of the problems is the emergence and spread of drug-resistant forms of tuberculosis, which cannot be treated with most of the known drugs.

Patients suffering from drug-resistant mycobacterium tuberculosis require two years of treatment, as well as expensive antibacterial drugs. Resistant tuberculosis is more likely to occur if a patient being treated for a common form takes an incomplete set of antibiotics or interrupts the course of treatment ahead of time.

In recent years in Russia, due to problems with the procurement of drugs for the treatment of tuberculosis, almost every patient with tuberculosis was unable to complete the full course of treatment. A large number of drugs used for the treatment of tuberculosis are represented on the Russian pharmaceutical market. It is important to provide patients with information about the entire range of anti-tuberculosis drugs on the Russian and regional markets.

In the structure of the assortment of drugs for the treatment of tuberculosis, Russian-made drugs prevail - 53.5%. Foreign drugs are mainly represented by pharmaceutical companies in India (33\u003e 7%)\u003e Germany (4.5%), Ukraine (1.3%), the share of other countries is less than 1%.

A significant number of synonyms of domestic production is characteristic of the hydrazide group (92.1%); only three drugs for the treatment of tuberculosis are imported: Isoniazid (Belarus), Isoniazid-Darnitsa (Ukraine), Izosid comp. (Germany).

The share of drugs - aminoglycosides, produced in the Russian Federation (registration began in 1964), accounts for 84.2% of drugs in this group.

Pharmsintez OJSC ranks first among 24 domestic manufacturers. Well-known foreign pharmaceutical companies that have registered anti-TB drugs in Russia include Macleods Pharmaceuticals Ltd (India), Lupin Laboratories Ltd (India), Fatol Arzneimittel GmbH (Germany), Eli Lilly (USA), Sanofi Aventis (France).

It is customary to divide anti-tuberculosis drugs into three groups: first-line drugs (basic): isoniazid, rifampicin, pyrazinamide, ethambutol, streptomycin; the second (reserve) - cycloserine, ethionamide, prothionamide, kanamycin, capreomycin, amikacin, PASK, fluoroquinolones; the third (alternative) - clarithromycin, clofazimine, amoxiclav.

Imported analogues of drugs against tuberculosis

Combined effective drugs: Isoniazid + Pyrazinamide + Rifampicin (Russian analogue of Protub-3):

Zuccox - Glaxo India (India);
Rifater- Marion Merrell Bourgeois (France);
Phtizamax (Ftizamax)- MacLeods Pharmaceuticals (India)
Rimpin IPZ - Laika Labs Ltd. (India);

Drug Rifampicin (Rifampicin):

Eremfat(Eremfat) - Fatol Arzneimittel (Germany)

The drug Capreomycin (Capreomycin):

Capocin® (Capocin) - Macleods Pharmaceuticals (India)
Capastat® (Capastat®) - Teva Pharmaceutical Plant JSC (Israel)
Capreostat - Simpex Pharma (India)
Lycocin - Laika Labs Ltd. (India)

Anti-tuberculosis drugs (table)

INN	Lecform LS	F (inside),%	Т½, h *	Dosage regimen	Features of drugs
Isoniazid	Tab. 0.1 g; 0.15 g; 0.2 g; 0.3 g Rr d / in. 10% in amp. 5 ml each	80-90	1-4	Inside Adults: 4-6 mg / kg / day in one dose; with tuberculous meningitis - 10 mg / kg / day Children: 10-15 mg / kg / day (but not more than 0.3 g / day) in 1-2 doses Parenterally Adults: 0.2-0.3 g / day in one administration Children: 10-15 mg / kg / day (but not more than 0.3 g / day) in 1-2 administrations	One of the most effective first line anti-TB drugs. It has a bactericidal effect on mycobacteria at the stage of reproduction, bacteriostatically at rest. Average toxicity. Most common HPs: neurotoxic. Prophylactic use of pyridoxine is necessary
Metazid	Tab. 0.1 g; 0.3 g; 0.5 g	ND	ND	Inside Adults: 0.5 g every 12 hours Children: 20-30 mg / kg / day in 2-3 doses	An analogue of isoniazid. Less efficient
Opiniazide	Rr d / in. five %	ND	ND	Parenterally Adults: 0.5 g every 6-12 hours Endobronchial Adults: 2-3 ml 5% solution	An analogue of isoniazid. Less efficient
Ftivazid	Tab. 0.1 g; 0.3 g; 0.5 g	ND	ND	Inside Adults: 0.5 g every 8-12 hours Children: 20-40 mg / kg / day in 3 divided doses (but not more than 1.5 g / day)	An analogue of isoniazid. Less efficient
Rifampicin	Caps. 0.15 g; 0.3 g; 0.45 g Tab. 0.15 g; 0.32 g; 0.45 g; 0.6 g Por. d / in. 0.15 g; 0.6 g per bottle.	95	1-4	Inside Adults and children: 10-20 mg / kg / day (but not more than 0.6 g / day) in one dose 1 hour before meals Internally Adults: 0.45-0.6 g / day in one administration. Children: 10-20 mg / kg / day in one administration.	One of the most active first-line anti-TB drugs. Bactericidal action. Average toxicity. The most common HPs are hepatotoxic. May stain urine, phlegm and saliva red. Has clinically significant interactions with many drugs (see text and section "Drug Interactions")
Rifabutin	Caps. 0.15 g	95-100	16-45	Inside Adults: 0.15-0.6 g / day at one time	PTP series II. The structure and properties are similar to rifampicin. Differences: - more active against atypical mycobacteria terium; - bioavailability does not depend on food intake; - can cause uveitis; - interacts with a smaller number of drugs; - not applicable to children under 14 years old
Pyrazinamide	Tab. 0.5 g; 0.75 g	80-90	9-12	Inside Adults: 1.5-2.0 g / day in one dose daily or 2.0-2.5 g / day ґ 3 times a week Children: 20-40 mg / kg / day in one dose	Weak bactericidal effect. Pronounced "sterilizing" effect. Low toxicity. Most common HPs: gastrointestinal
Ethambutol	Tab. 0.1 g; 0.2 g; 0.4 g; 0.6 g; 0.8 g; 1.0 g	75-80	3-4	Inside Adults: 15-20 mg / kg / day in one dose daily or 30 mg / kg / day ґ 3 times a week Children: 15-25 mg / kg / day (but not more than 2.5 g / day) in one dose	1st line anti-TB drugs with average efficiency. It has a bacteriostatic effect. Active only against multiplying mycobacteria. Low toxicity. Most common ADRs: gastrointestinal and visual impairment (visual control required)
Cycloserine	Caps. 0.25 g Tab. 0.25 g	70-90	10	Inside Adults: 0.25 g every 12 hours for 2 weeks, then 10-20 mg / kg / day in 2 divided doses Children: 10-20 mg / kg / day (but not more than 1 g / day) in 2 divided doses	Bacteriostatic or bactericidal effect, depending on concentration. High toxicity. The most common HPs: neurotoxic and gastrointestinal
Ethionamide, prothionamide	Dragee 0.25 g Tab. 0.25 g	ND	2-3	Inside Adults and children: 15-20 mg / kg / day (but not more than 1 g / day) in 1-3 doses	Second-line anti-TB drugs with average efficiency. Average toxicity. The most common HPs are gastrointestinal and hepatotoxic. Not assigned to children under 14 years old
PASK	Gran. d / ingestion Tab. 0.5 g	ND	0,5	Inside Adults: 10-12 g / day in 3-4 doses Children: 200-300 mg / kg / day (bottom not more than 12 g / day) in 2-3 doses It is recommended to start with small doses and gradually increase them.	Second-line anti-TB drugs with moderate effectiveness. Bacteriostatic action. Average toxicity. Poorly tolerated due to frequent GI HPs
Thioacetazone	Tab. 10 mg; 25 mg; 50 mg	ND	13	Inside Adults: 2.5 mg / kg / day in one dose Children: 4 mg / kg / day at one time	Second-line anti-TB drugs with low efficiency. Bacteriostatic action. Average toxicity. The most common HPs: hepatotoxic, gastrointestinal and hematological
Capreomycin	Por. lyoph. d / in. 1.0 g	-	4-6	V / m Adults and children: 15-30 mg / kg / day (but not more than 1 g / day) in one administration	PTP series II (not included in the MSTBL classification). Bacteriostatic action. Average toxicity. Most common ADRs: nephrotoxic and ototoxic
Combined drugs
Rifampicin / isoniazid / pyrazinamide	Tab. 0.12 g + 0.05 g + 0.3 g	ND	ND	Inside Adults: less than 40 kg - 3 tab. per day; 40-49 kg - 4 tab. per day; 50-64 kg - 5 tab. per day; from 65 kg - 6 tab. per day; at one time 1 hour before meals	Synergistic action. Expressed bactericidal and "sterilizing" effect. It is used in the first phase of tuberculosis therapy. May enter into clinically significant drug interactions (rifampin)
Ethambutol / isoniazid / rifampicin	Tab. 0.3 g + 0.075 g + 0.15 g	ND	3	Inside Adults: 40-49 kg - 3 tab. per day; from 50 kg - 4-5 tab. per day; at one time 1 hour before meals	Synergistic action. Can be used for intensive and long courses. Possible summation of the hepatotoxicity of rifampicin and isoniazid. Vision control required (Ethambutol + Isoniazid)
Ethambutol / isoniazid / rifampicin / pyrazinamide	Tab. 0.225 g + 0.062 g + 0.12 g + 0.3 g	ND	ND	Inside Adults: 1 tablet / 10 kg / day Max. daily dose - 5 tablets.	Synergistic action. It is used in the I (intensive) phase of tuberculosis therapy. Possible summation of the hepatotoxicity of rifampicin and isoniazid. Vision control required
Rifampicin / isoniazid	Tab. 0.15 g + 0.1 g Tab. 0.3 g + 0.15 g	ND	ND	Inside Adults: 0.45-0.6 g / day (in terms of rifampicin) in one dose 1 hour before meals	Synergistic action. Possible summation of hepatotoxicity components
Rifampicin / isoniazid / pyridoxine	Tab. 0.15 g + 0.1 g + 0.01 g	ND	ND	Inside Adults: 3-4 tab. per day at one time 1 hour before meals	Synergistic action of isoniazid and rifampicin. Possible summation of the hepatotoxicity of isoniazid and rifampicin. Pyridoxine prevents the development of HP
Isoniazid / ethambutol	Tab. 0.15 g + 0.4 g	ND	ND	Inside Adults: 5-10 mg / kg / day (for isoniazid) in one dose.	The combination of isoniazid and ethambutol enhances the anti-tuberculosis effect and slows down the development of mycobacterial resistance
Isoniazid / pyrazinamide	Tab. 0.15 g + 0.5 g	ND	ND	Inside Adults: 5-10 mg / kg / day (for isoniazid) in one dose	Strengthening the bactericidal effect. "Sterilizing" action

* With normal renal function, ND - no data

Literature:

Ovod A.I., Filippova O.E. Analysis of the assortment of drugs for the treatment of patients with tuberculosis // Scientific Bulletin of BelSU. Series: Medicine. Pharmacy. 2012. No. 10 (129).
Borisov S.E.Etiotropic treatment of tuberculosis with drug resistance of M. tuberculosis / S. E. Borisov, GB Sokolova // Consilium Medicum.
A practical guide to anti-infectious chemotherapy (Ed. By LS Strachunsky, Yu.B. Belousov, SN Kozlov), 2007 NIIAH SGMA.

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How are pulmonary TVS treated today - we will analyze all the newest

Tuberculosis is a dangerous and very common disease. For quite a long time, the disease practically did not respond to treatment, but now the pills for tuberculosis effectively fight the disease, reduce the risk of complications and save lives.

The chronic infection process is caused by various strains and occurs most often in the lungs in adults. Infection occurs directly through contact with an infected person. Bacteria enter a healthy body even with simple communication, airborne droplets, kissing and sneezing.

Today, if you regularly take special pills, you can kill Koch's wand. The photo of the pathogen shows its structure - a straight and slightly curved bacterium.

They do not appear immediately, which seriously complicates the diagnosis and treatment process.

Hospitalization and taking medications is carried out at all stages of tuberculosis and with the following manifestations:

increased body temperature up to 37-38 degrees for a long period;
hemoptysis;
rapid weight loss;
complaints of constant headache;
increased sweating, especially at night.

The duration of therapy, as well as its outcome, depends not only on the prescribed pills, but also on the body's defenses. The doctor develops an individual treatment regimen, taking into account the age, course of the disease and the patient's condition.

On average, the course lasts from 6 months to a year and a half. Most often, the infectious process is observed in middle-aged and elderly men.

Modern classification of drugs

Tuberculosis pills act differently on the pathogen. Successful treatment depends on taking four or more types of tablets daily for more than one month.

The fight against a difficult disease is taking place at the international level, therefore a generally accepted classification has been created:

The group of drugs with the highest efficiency.
Means with medium activity against mycobacteria.
Lower potency tablets or reserve group.
Combined funds.

Each category consists of antibacterial and other modern chemicals, which in combination with each other create a good therapeutic effect for tuberculosis. After a thorough examination of the patient, the doctor prescribes pills for tuberculosis. The choice of drugs is also influenced by the form of the disease, its manifestations and the individual characteristics of a person.

First-line drugs

The first group has been used for a long time. Isonicotinic acid derivatives include isoniazid, as well as rifampicin, ftivazid. All medicinal substances are highly active in the fight against the infectious process.

The dosage of any type of medicinal substance is developed and recommended by WHO:

First-line drugs	Basic properties
Isoniazid	The bactericidal effect of isoniazid against mycobacteria stops their development and reproduction. The medicine is a derivative of isonicotinic acid, which is why its name comes from. The remedy is prescribed in the active phase of the disease, but it must be combined with other drugs, since the body's resistance develops. The drug is highly active in the treatment of pathology in both children and adults. The active substance acts inside and outside the bacterial cell.
Rifampicin	Semi-synthetic rifampicin tablets show good results in the treatment of a dangerous ailment. Ref tablets for tuberculosis are a broad-spectrum antibiotic, but they have a number of limitations. Many mycobacterial species quickly acquire resistance to the main component, which significantly reduces its use. The drug is available in the form of tablets, capsules and syrup. Severe disorders of the internal organs are very rare.

Second-line drugs

The second group includes the drug tsilkoserin, streptomycin, kanamycin, amikacin and others. Medicines from the group reduce the inflammatory process in the patient's lungs, reduce the growth and reproduction of harmful microorganisms.

If the substances from the first row do not cope with their task, then the second group is connected. The result is achieved after about a year of continuous treatment.

Second-line drugs	Basic properties
Cyloserine	A common drug is tsilkoserine, which is one of the earliest natural antimicrobials. The advantage of the substance is that there is practically no resistance to it, even with prolonged therapy. Adverse reactions occur from the gastrointestinal tract, there is rarely an allergy to the drug. Depending on the dose, tsilkoserine has a bacteriostatic and bactericidal effect on a tubercle bacillus.
Prothionamide	The bacteriostatic effect against bacteria is shown by the second-line drug proteonamide. In pathogenic microorganisms, resistance to the active substance of tablets develops rather quickly, therefore they are often prescribed only when other means are prohibited. In combination with some drugs from the first group, convulsions and other pathologies often occur.
PASK (paraaminosalicylic acid)	The anti-tuberculosis effect is manifested in paraaminosalicylic acid - PASK tablets for tuberculosis. The agent affects the development of bacteria. Pathogens that have penetrated the cell do not respond well to tablets. The drug occasionally causes nausea, dizziness, and allergic reactions. Most often, when treating PASK, the mucous membrane of the gastrointestinal tract suffers. The drug is chosen in case of intolerance to other representatives of the second category.
Capreomycin	With a low result of first-line agents or allergic reactions of the body, antibacterial substances are chosen, among which capreomycin. With the right combination of tablets and regular kidney examinations during treatment, many side effects can be avoided. The drug is prescribed only in combination with other drugs.

Third-tier and combined group

Lower activity against pathogenic microorganisms is possessed by third-line agents. They are used mainly for intolerance to chemicals from groups 1 and 2.

Thiocetazone

Thiocetazone tablets for the treatment of tuberculosis are produced synthetically. The drug is very toxic and is used less and less today. Among the contraindications are diseases of the stomach and intestines, diabetes mellitus and impaired renal function.

Combined funds

First-line drugs are combined into one combination product. Such anti-tuberculosis pills are convenient to use, because you do not need to drink a lot of drugs at a time.

Yet the disadvantage of this group is the summation of side effects. Treatment is not always prescribed if patients have problems with the heart, liver and kidneys, for elderly people. They are also used as supportive therapy.

Possible contraindications and side effects

Drugs for the treatment of tuberculosis from any group are potent substances and are dangerous to health if taken uncontrolled. High toxicity limits pill intake in children.

Today there is no data on the effect of chemicals on the fetus, therefore they are not prescribed during pregnancy and lactation.

The main limitations to most anti-tuberculosis drugs are:

chronic and acute kidney and liver diseases;
epilepsy;
period of bearing a child;
lactation;
stomach ulcer;
heart pathology;
hearing aid problems;
individual sensitivity to the active substance.

Funds are used with caution in childhood. Some tablets are not used until the age of 14. In older people, at the slightest disturbance in the work of the kidneys, the toxic effect increases. The instruction indicates possible contraindications for use.

Among the main side reactions of the body are:

nausea and vomiting;
sleep disturbance;
loss of body weight;
psychical deviations;
allergic reaction;
violation of normal stool;

If at least one symptom appears, discontinue use and seek medical attention.

Important! The side effect of any of the anti-tuberculosis drugs increases dramatically with the use of alcoholic beverages and tobacco products.

What to do to prevent disease

The main goal of high-quality disease prevention is the timely detection of pathology.

Regular medical examinations will allow early treatment of tuberculosis and isolation of the patient from other people.
Tablets for sure supplement with good nutrition, intake of vitamin and mineral complexes.
If there is a surge in the tuberculosis epidemic, an additional survey of the population is prescribed.
In children, any preventive measures are carried out only under the strict supervision of a doctor. These procedures include the Mantoux test.
In adults, the main diagnostic method will be fluorography (see).

The latent chronic process gradually reduces immunity, the fight against the disease becomes more and more difficult. Timely diagnosis of pathology will always be an important step.

To get the maximum result from the treatment, you must strictly adhere to the doctor's recommendations and in no case skip taking medications. Modern pills for tuberculosis, with proper treatment, save lives of many people.

Modern pharmacology provides many medicines to combat lung diseases, in particular, to eliminate the symptoms of tuberculosis. In this rather extensive list, one of the leading places is occupied by tablets for tuberculosis Isoniazid - a modern powerful drug of bacteriostatic action.

Isoniazid (tubazid) is a drug developed against the pathogens of tuberculosis. The main component of the Isoniazid preparation - Isonicotinic acid hydrazide - is a bitter white crystalline powder, odorless. The product is highly soluble in water, the tablets are sensitive to light and air. 1 tablet contains 0.3 g of Isoniazid and excipients (potato starch, calcium stearate, stearic acid). Isoniazid comes in the form of white tablets with a flat surface and a risk. The blister contains 10 tablets, 1 cardboard box contains 10 blisters.

Isoniazid :: drug release form

Pharmacological group

Isoniazid is considered a first-line anti-tuberculosis drug. Treatment of tuberculosis occurs through the destructive action of the medication on Koch's sticks - the microorganisms that provoke the disease. Equally effective on pathogens located outside and intracellularly. The highest degree of efficiency is achieved with acute processes. Provides additional antibacterial and bactericidal action. Not effective against other pathogens of infectious diseases.

The drug is well absorbed from the gastrointestinal tract (taking Isoniazid together with food reduces absorption). The highest concentration of the agent in the blood is found 1-4 hours after oral administration. The harmful effect for tuberculosis bacteria lasts from 6 to 24 hours. The medication easily overcomes the blood-brain barrier between brain tissue and blood, and body fluids are also supplied. It is excreted by the kidneys.

Indications and contraindications for use

Isoniazid is indicated for use in all forms of active tuberculosis and tuberculous meningitis. It is also effective in preventing this disease:

To persons who have direct contact with patients with bacillary tuberculosis.
Adolescents and children in contact with tuberculosis patients in educational institutions or living together.
Children and adolescents in case of primary infection with tuberculosis.
Adults who have residual tuberculous manifestations.
HIV-infected persons in case of an observed decrease in immunity.
Livestock breeders with cattle affected by tuberculosis.

The medicine for tuberculosis Isoniazid has a number of contraindications for use:

intolerance to the components of the drug;
a history of poliomyelitis;
epilepsy, frequent convulsions;
psoriasis;
mental disorders;
pathology of the peripheral nervous system;
renal, liver failure;
bronchial asthma;
cirrhosis of the liver;
pathology of the optic nerve;
hypertension 2-3 tbsp.
ischemia, atherosclerosis;
eczema;
pulmonary heart failure 3 tbsp.

Features of the drug, dosage

Isoniazid is administered orally. The tablets are drunk after a meal, the medicine taken with food becomes ineffective. How to take Isoniazid for tuberculosis for a specific patient is determined by a specialist.

Council. During the treatment of tuberculosis with Isoniazid, the patient should adhere to a certain diet. In particular, cheese and some fish varieties (tuna, sardinella) should be excluded from the diet. These foods increase the risk of side effects due to enzyme suppression.

The average daily dose of the drug is 300-900 mg. The dosage of Isoniazid directly depends on the following factors:

the form and severity of the pathology;
the metabolic rate of Isoniazid in the body of a particular patient;
individual tolerance of the drug components;
the presence or absence of additional diseases.

In order to prevent the resistance of the tuberculosis pathogen Ioniazid, the latter can be prescribed for use in parallel with similar anti-tuberculosis drugs.

By the way, Ioniazid is admissible for children, however, some parents, having read the instructions, refuse to apply the remedy to the child in order to prevent tuberculosis. Most often, the refusal is explained by the absence of the main manifestations of the disease in children. However, not all parents are aware that in the first months tuberculosis may not manifest itself in any way (i.e., it may proceed in a latent form). During this period, Isoniazid will assist the child's immune system in the fight against pathogens.

How to take Isoniazid for tuberculosis

Adults and children over 14 years old: 300 mg 1 time per day or according to the scheme: 15 mg per kilogram of weight per day (taken 2-3 times a week). The maximum daily dosage of Isoniazid for tuberculosis is 900 mg, a single dose is 600 mg.

Children under 14 years old: 10-20 mg per kilogram of body weight per day (up to 300 mg) or 20-40 mg per kilogram of body weight 2-3 times a week. The maximum daily dose is 500 mg.

For prophylaxis: 5-10 mg per kilogram of body weight per day. Divided into 2 doses, the course of treatment is 2 months.

Use of the drug during pregnancy and lactation

During the period of bearing a child, the drug can be used strictly as directed by a specialist, when the risks to the fetus and the benefits to the mother have been compared. In such cases, the daily dosage should not exceed 10 mg per kilogram of body weight. The drug is not suitable for taking by nursing mothers (but it is allowed to curtail breastfeeding during the course of Isoniazid therapy for tuberculosis).

Isoniazid tuberculosis pills - possible side effects

The action of the drug Isoniazid can provoke side effects and complications in the work of body systems:

Of cardio-vascular system:

increased pressure;
increased heart rate;
angina pectoris.

Nervous system:

numbness of the limbs;
headaches, dizziness;
weakness, fatigue;
irritability;
sleep disorders;
depression;
convulsions;
memory impairment.

nausea, vomiting;
jaundice;
toxic hepatitis (rare).

Hematopoietic organs:

agranulocetosis;
anemia.

Also, taking the drug can provoke allergic reactions of the body in the form of itching, fever, vasculitis. Much less often, while taking Isoniazid, there is a tendency to hemorrhage and bleeding.

In case of an overdose of the drug in the period from 30 minutes to 3 hours, the following symptoms may appear:

nausea, vomiting;
blurry speech;
dizziness;
visual disturbances, visual hallucinations;
depression of the central nervous system;
convulsions.

With the use of Isoniazid, tuberculosis treatment is carried out quickly and efficiently. Nevertheless, given the possibility of side effects, it is recommended to consult a specialist before using the drug. Self-medication in the treatment of pulmonary diseases is unacceptable, since it can provoke irreversible consequences for health.