How to effectively treat pulmonary tuberculosis? Anti-tuberculosis drugs: a list of the best. A modern approach to the complex treatment of tuberculosis.

Tuberculosis is one of the most common infectious diseases. Both humans and animals can become infected. Previously, the disease was considered incurable. However, today the infection is treatable in most cases. And it is even possible to treat tuberculosis with folk remedies at home.

Comprehensive treatment helps remove the pathogen from the body. It is this approach that allows you to achieve maximum recovery results.

The disease tuberculosis has long been known as consumption. The first researchers could not determine the cause of the disease for a long time. But Robert Koch showed the whole world in the 19th century that disease is an infection. It is caused by mycobacterium, which was named after the researcher.

The most common route of transmission is airborne. can be transmitted by coughing, sneezing and even talking. A person with a strong immune system does not become infected with tuberculosis when mycobacteria enters the body. Even in the respiratory tract, the immune system destroys the pathogen.

But if contact with a sick person is prolonged, or the infection is quite massive, then a healthy person can become infected. Therefore, it is important to know all the symptoms of the disease in order to consult a specialist in time.

The incubation period of the disease lasts 3-12 weeks.

At this stage, the first symptoms appear, and the patient himself is not yet contagious. This is a big problem, since mild symptoms can be mistaken for any respiratory illness. Before treating pulmonary tuberculosis, a diagnosis is carried out, thanks to which several research methods can be used simultaneously.

Diagnosis of tuberculosis

There are ways to quickly and reliably check for the presence of infection in the body. However, such research requires a lot of money. The traditional method for diagnosing the disease is the Mantoux test.

3 days after vaccination you can already understand if the bacillus is in the body. But the reliability of this method leaves much to be desired.

Another simple and inexpensive method is microscopic analysis of smears. But in this way, you can easily confuse Koch's bacillus with other bacteria.

A sputum culture method is often used. But it is only able to detect large bacteria. Therefore, you can often get a negative answer from the doctor about the presence of an infection, while the small bacillus successfully develops in the body.

X-ray examination of the lungs can give good results for diagnosing the disease. Examination of the patient also has a good effect.

Specialized medical institutions test antibodies to the rod. Such a study helps determine the presence of immunity from the disease.

If symptoms suggest the presence of bacteria in the body, polymerase chain reaction testing is often performed today, in which sputum is analyzed.

It is the most reliable method, with 95% accuracy of results.

Treatment of tuberculosis

There are many different methods for treating tuberculosis. The disease should be treated only with a comprehensive method. Treatment should be aimed at destroying the bacteria, getting rid of the symptoms that have arisen, restoring the immune system and the entire body. Sometimes surgery is required.

Typically, the course of treatment lasts from 6 to 8 months. The duration is influenced by the stage of development of the disease and the presence of concomitant diseases. It often takes much longer to heal. Among other factors, the bacterium itself can affect the long-term treatment. It is well resistant to various drugs, then it will not be possible to quickly cure tuberculosis.

Drug treatment

The source of inflammation is inhabited by more than one mycobacterium. Microorganisms multiply quickly and spread throughout the body, making the healing process difficult. Therefore, the process of drug treatment consists of two stages: intensive and final. This is the only way to completely cure pulmonary tuberculosis.

The first stage is to suppress bacteria. The process targets bacteria with high metabolic activity. The second stage of treatment suppresses the remaining bacteria. This stage allows you to avoid further proliferation of microorganisms.

The phthisiatrician will prescribe a treatment regimen with changes in medications and their regimen. In order to completely cure a patient of tuberculosis, after completing a course of therapy, it is necessary to carry out maintenance treatment over the next year. For this purpose, 3 medications are prescribed.

Patients have to treat pulmonary tuberculosis at home with periodic visits to the doctor.

The recovery process is very long and requires the patient to be fully aware of the danger, which must strictly adhere to all the doctor’s instructions.

Pathogenetic treatment

This therapy is aimed at blocking the mechanisms of disease development. The disease can be completely cured only by adhering to a diet, physical activity, and restoration of the immune and hormonal systems.

The influence of the bacterium greatly disrupts human metabolism. Therefore, it is important to follow a diet that limits the amount of nutrients like proteins, fats, carbohydrates, minerals and vitamins. The patient should take about 90 g of fat per day. Therefore, treatment of tuberculosis at home is often carried out with badger fat.

In addition to basic treatment, detoxification is also required. Plasmapheresis is used for this. In some cases, restoration of the hormonal system is required. To do this you need to take Prednisolone. The course of treatment lasts about a month and a half, taking up to 20 mg once a day.

Also, to restore the body’s performance, various procedures are prescribed that can restore damaged cells or simply put the internal organ systems in order.

Surgical intervention

In more complex cases, tuberculosis is treated with surgery. This is approximately 5th of all cases. Surgical treatment is used not only for severe stages of the disease, but also in case of complications.

This intervention prevents death. Intrapulmonary bleeding can damage the entire respiratory system, making it impossible for a person to breathe.

If the disease has grown too much, the infected part of the lungs is removed. This method is used if there is no way to treat the disease. The spread and reproduction of mycobacteria occurs quite quickly. Therefore, to avoid surgery, you need to consult a doctor in a timely manner.

Treatment during pregnancy

Tuberculosis and pregnancy are incompatible things. Both the expectant mother and the fetus suffer from tuberculosis. All possible consequences are determined individually.

There are drugs that can be taken during pregnancy: Isoanid, Tubazid, etc. After the birth of a child, a pulmonary infection can be transmitted to him. Therefore, both mother and child should be under the supervision of a phthisiatrician. Pregnancy can aggravate the development of the disease or stabilize the condition. Therefore, the attending physician must report all possible risks.

Treatment of tuberculosis with folk remedies

Treatment with alternative medicine methods should be agreed with a doctor. Treatment with folk remedies must also be monitored by tests and examinations. If it is difficult to find a folk recipe for how to cure tuberculosis, you can even ask your doctor.

There is one rule that must be followed. This is a refusal to drink alcohol and smoke. It is also necessary to select a diet that will fill the body with useful substances as much as possible.

Fruits and vegetables are helpers in the fight against illness.

Many people have already been treated with traditional methods, and this has given visible results.

Medvedka remedy

The most effective folk remedy against tuberculosis is the use of dried mole cricket. In this way, tuberculosis can be cured relatively quickly and reliably. To do this, you need to dry and grind the mole cricket. Can be consumed with honey.

Mole cricket leukocytes are capable of dissolving mycobacteria. Treatment consists of 2 stages. The product is used for 3 days. Then after 3 months the course is repeated. This medicine also promotes the formation of a profuse wet cough, which allows you to completely remove pus from the lungs.

Wax moth remedy

The main advantage of the product is the complete absence of side effects. 5 g of larvae need to be filled with 50 ml of ethyl alcohol. The tincture should stand in a dark place for 1 week. When taken per glass of water, only 0.5 ml is used. You need to use it 2 times a day.

Many people doubt whether tuberculosis can be cured at home using folk remedies. However, even TB specialists actively recommend such treatment. It can destroy Koch's bacillus without damaging the body's cells. And the requirements for taking such drugs are much lower than for medications.

Disease prevention

Pulmonary tuberculosis usually affects a certain social class of the population.

Unsanitary conditions– these are favorable conditions for the development and spread of the disease.

To protect yourself from infection, you need to support your immune system. After all, a strong immune system can fight off infection on its own. To do this, you need to eat well, take vitamins and lead an active lifestyle.

In air, the bacterium can live up to 10 days. Therefore, if you inhale a particle of dust that contains mycobacteria, you can easily become infected.

You can also become infected even if you consume milk that has been milked from a cow with tuberculosis. So knowing all the signs of the disease is a must for every person. After all, the sooner you take action, the easier and faster it will be to overcome tuberculosis.

Tuberculosis can be caused by two members of the family Mycobacteriaceae squad Actinomycetales: M. tuberculosis And M. bovis. In addition, it is sometimes mentioned M.africanum- a microorganism that occupies an intermediate position between M. tuberculosis And M. bovis and in rare cases being the cause of tuberculosis on the African continent. The above microorganisms are combined into a complex M. tuberculosis, which is actually a synonym M. tuberculosis, since the other two microorganisms are relatively rare.

Man is the only source M. tuberculosis. The main method of transmission of infection is airborne droplets. Rarely, infection can be caused by drinking milk that is contaminated M. bovis. Cases of contact infection among pathologists and laboratory personnel have also been described.

Typically, long-term contact with the bacteria-releasing agent is necessary for infection to develop.

Selecting a therapy regimen

Clinical forms of tuberculosis have little effect on the chemotherapy technique; the size of the bacterial population is more important. Based on this, all patients can be divided into four groups:

I. Patients with newly diagnosed pulmonary tuberculosis (new cases) with positive smear results, severe abacillary pulmonary tuberculosis and severe forms of extrapulmonary tuberculosis.

II. This category includes persons with a relapse of the disease and those in whom treatment did not produce the expected effect (positive sputum smear) or was interrupted. Once the initial phase of chemotherapy is completed and the sputum smear is negative, the continuation phase begins. However, if mycobacteria are detected in sputum, the initial phase should be extended for another 4 weeks.

III. Patients suffering from pulmonary tuberculosis with limited parenchymal involvement and having negative sputum smears, as well as patients with non-severe extrapulmonary tuberculosis.

A significant part of this category consists of children, in whom pulmonary tuberculosis almost always occurs against the background of negative sputum smears. The other part consists of patients infected during adolescence who developed primary tuberculosis.

IV. Patients with chronic tuberculosis. The effectiveness of chemotherapy for patients in this category is low even at present. It is necessary to use reserve drugs, the duration of treatment and the percentage of adverse reactions increases, and high voltage is required from the patient himself.

Treatment regimens

Standard codes are used to designate treatment regimens. The entire course of treatment is reflected in two phases. The number at the beginning of the code shows the duration of this phase in months. The number below the letter is placed if the drug is prescribed less than 1 time per day and indicates the frequency of administration per week (for example, E 3). Alternative drugs are indicated by letters in brackets. For example, the initial phase of 2HRZS(E) means daily administration of isoniazid, rifampicin, pyrazinamide in combination with either streptomycin or ethambutol for 2 months. After completion of the initial phase and a negative sputum smear microscopy result, the continuation phase of chemotherapy begins. However, if after 2 months of treatment mycobacteria are detected in the smear, the initial phase of treatment should be extended by 2-4 weeks. In the continuation phase, for example 4HR or 4H 3 R 3, isoniazid and rifampicin are used daily or 3 times a week for 4 months.

Table 3. Example of four-component therapy for tuberculosis (in adults)
directly observed, including 62 doses of drugs

First 2 weeks (daily)
Isoniazid	0.3 g
Rifampicin	0.6 g
Pyrazinamide	1.5 g with body weight less than 50 kg	2.0 g with body weight 51-74 kg	2.5 g with body weight more than 75 kg
Streptomycin	0.75 g with body weight less than 50 kg	1.0 g with body weight 51-74 kg
3-8 weeks (2 times a week)
Isoniazid	15 mg/kg
Rifampicin	0.6 g
Pyrazinamide	3.0 g with body weight less than 50 kg	3.5 g with body weight 51-74 kg	4.0 g with body weight more than 75 kg
Streptomycin	1.0 g with body weight less than 50 kg	1.25 g with body weight 51-74 kg	1.5 g with body weight more than 75 kg
9-26 weeks (2 times a week)
Isoniazid	15 mg/kg
Ethambutol	0.6 g

CHEMOTHERAPY REGIMS LESS THAN 6 MONTHS DURATION

Some researchers report good results from 4- and even 2-month courses of chemotherapy for mild forms of tuberculosis. However, most experts do not recommend stopping treatment earlier than after 6 months.

THERAPY OF MULTI-RESISTANT TUBERCULOSIS

In each specific case, it is advisable to determine the sensitivity of mycobacteria to anti-tuberculosis drugs. If resistance to first-line drugs is detected, alternative drugs are used, such as fluoroquinolones (ofloxacin, ciprofloxacin), aminoglycosides (kanamycin, amikacin), capreomycin, ethionamide and cycloserine.

REPEATED COURSE OF THERAPY

The approach to a second course of therapy depends on the following circumstances:

1. Relapse after sputum negativization usually indicates that previous treatment was stopped prematurely. In most cases, the sensitivity of the pathogen is maintained and a positive effect is observed when standard initial therapy is prescribed.
2. Relapse is due to resistance to isoniazid. In this case, a second course of chemotherapy with rifampicin is prescribed in combination with two other anti-tuberculosis drugs to which sensitivity is preserved, for a total duration of 2 years.
3. Relapse after irregular use of anti-tuberculosis drugs is often caused by resistant mycobacteria. In this case, it is necessary to quickly determine sensitivity and prescribe drugs to which sensitivity is preserved.
4. If resistance is suspected, the therapy regimen is changed using drugs to which sensitivity is presumably preserved.
5. Multiple resistance to the most “powerful” drugs -

Treatment of pulmonary tuberculosis requires a long-term, comprehensive approach. For this purpose, special chemotherapy has been developed based on several components.

General rules

Treatment of pulmonary tuberculosis in adults should be carried out with several medications and without interruption. As a rule, the scheme uses 4-5, which must be taken every day for six months.

The active ingredients have different effects on mycobacteria, and only in combination is it possible to completely destroy mycobacteria. In addition, immunomodulatory medications are mandatory.

Breathing exercises and physiotherapy are also necessary. Otherwise, mortality can reach up to 50% in the active form. The second 50%, if left untreated, become a chronic disease.

Treatment of such a disease must be carried out under the supervision of a doctor - self-medication can lead to mycobacterial resistance and a more advanced stage.

Algorithm of actions

How is pulmonary tuberculosis treated in adults? Recovery requires the implementation of certain goals:

1. Eliminate laboratory signs and clinical manifestations of the disease.
2. Restore human performance.
3. Stop the release of mycobacteria into the environment, which must be confirmed by laboratory tests.
4. Eliminate various signs of the disease with confirmation of their absence by an x-ray procedure.

Attention! If it is not possible to carry out a full course, it is better to postpone therapy than to interrupt it. All medications must be taken daily without a break.

Where is therapy performed?

Treatment of pulmonary tuberculosis in adults is carried out over a long period with mandatory medical supervision at each stage.

Surgical intervention

A significant number of patients with various types of Mycobacterium tuberculosis require surgery to cut off the source of inflammation of the lung tissue.

Surgical treatment of pulmonary tuberculosis is necessary in the following cases:

1. There are cavities that can release phlegm and spread bacteria. However, conservative treatment for 3-6 months was not successful. In some cases, dangerous bleeding from cavities is possible. Large cavities are formed, due to which cavities cannot be scarred on their own, which leads to an even greater spread of infection and possible relapses.
2. There are foci of inflammation without mycobacteria. Prescribed drugs cannot sterilize these lesions due to their inability to penetrate fibrous tissue.
3. The presence of cicatricial strictures of the bronchi after the lesion.
4. Foci of infection caused by atypical mycobacteria that are not amenable to drug treatment.
5. Complications in the form of accumulation of pus in the pleural cavity or collapse (low pressure) of the lung.
6. The development of neoplasms of unknown etiology (the cause of the disease).

Surgical intervention is necessarily combined with enhanced therapy with anti-tuberculosis drugs. If treatment is incorrect, a treatable stage may develop into a difficult-to-treat condition due to drug resistance.

In addition to resection (complete removal) of the lung, drainage (suction of fluid) of the pleura or lung tissue caverns is possible, as well as the use of artificial pneumothorax (accumulation of air).

Three component circuit

At the time when anti-tuberculosis therapy first appeared, the following scheme for combating the disease was formed:

• Streptomycin.

These substances have been used to treat pulmonary tuberculosis for decades, helping to save many lives.

Four component circuit

With the beginning of active medical care, strains (genus of viruses) of mycobacteria became more resistant to medications. The next step was the development of a first-line quadruple therapy:

• Streptomycin/kanamycin;
• Rifabutin/;
• Isoniazid/ftivazid;
• Pyrazinamide/ethionamide.

Interesting! Such principles for combating the disease were developed by the Dutch doctor Karel Stiblo in 1974. 20 years later, the World Health Organization recognized Stiblo's model of tuberculosis control, calling it the DOTS strategy and recommending it for countries with high incidence of Mycobacterium tuberculosis.

Some experts believe that the Soviet strategy for treating pulmonary tuberculosis was more effective and comprehensive using anti-tuberculosis dispensaries, compared to Dr. Stiblo's methods.

Five component circuit

Today, many experts prefer to enhance the regimen with an additional fluoroquinolone-based substance, for example, ciprofloxacin. Given the rise in drug-resistant diseases, treatment is becoming an increasingly complex issue.

Therapy includes antibiotics of the second, third and later generations. The effectiveness of such drugs occurs after daily use for 20 months or longer.

However, the cost of second- and higher-generation antibiotics is much more significant than the first-line course. In addition, side effects from such medications occur more often.

Even with four or five component regimens, mycobacteria can exhibit resistance. Then, to eliminate pulmonary tuberculosis, treatment switches to second-line chemotherapy drugs - such as capreomycin, cycloserine.

Inflammation with Mycobacterium tuberculosis and the treatment method itself can lead to secondary diseases - anemia, hypovitaminosis, leukopenia. Therefore, attention should be paid to a varied diet, especially if there is significant weight loss.

Patients with a history of drug or alcohol addiction undergo detoxification before starting anti-tuberculosis therapy.

If there are diseases other than MBT for which immunosuppressive therapy (suppression of unwanted immune response) is used, then either it is canceled altogether, as far as the clinical picture allows, or the dosage is reduced.

HIV-infected people should undergo anti-HIV therapy in parallel with anti-tuberculosis therapy.

Glucocorticoids

These drugs have a pronounced immunosuppressive effect. Therefore, their use is extremely limited.

The indication for the use of glucocorticoids (steroids) is severe intoxication or acute inflammation. They are prescribed for a short-term course in small doses and always during five-component chemotherapy.

Related Methods

An important element of therapy is sanatorium-resort treatment. The thin air in the mountains facilitates oxygenation of the lungs, thereby reducing the growth and increase in the number of mycobacteria.

For the same purposes, hyperbaric oxygenation is used - the use of oxygen in special pressure chambers.

Additional Methods

Previously, in cases where the cavity did not shrink due to thick walls, the only solution was surgery. Nowadays, the method of valve bronchial blockade is more effective.

Its essence is that an endobronchial valve is introduced into the affected area, which allows maintaining the drainage function of the bronchus and creating hypoventilation. The valve is inserted through the larynx using local anesthesia (anesthesia).

The method has not yet received the widespread popularity it deserves due to the high cost of the equipment, and is also not independent - such operations are carried out in parallel, and not instead of chemotherapy.

Initial stage of the disease

Important. For a successful result, timely diagnosis is necessary. There are various laboratory methods to determine infection and morbidity.

How is early stage pulmonary tuberculosis treated? If, thanks to a correct assessment of the clinical picture (a long period of time, coughing, enlarged lymph nodes, nausea, weakness, pallor, a general decrease in immunity, sudden weight loss) and an X-ray examination, a specialist diagnoses tuberculosis, then through adequate treatment, results can be achieved through 6 months, less often – after two years.

As a rule, the following drugs are used for the initial stages:

• Pyrazinamide;
• Streptomycin;
• Rifampicin.

But the dosages of these drugs differ from cases of later stages and must be prescribed individually. It is also important, which must include fresh vegetables and fruits, whole grain bread, bran, jacket potatoes, eggs, and milk.

As a supplement, you can turn to traditional medicine. Treatment of pulmonary tuberculosis can be achieved not only with the help of medications.

Herbs and infusions will be an excellent addition to treatment

1. Marshmallow root infusion;
2. Decoction of coltsfoot leaves;
3. Ledum infusion;
4. Decoction of pine cones.

Each plant has its own dosage and frequency of administration.

Prevention

Preventive methods include maintaining overall health (varied physical activity and proper nutrition), eliminating bad habits (smoking, alcohol and drug addiction). An important factor is good social and living conditions.

We present to your attention an interesting educational film about tuberculosis. Be sure to watch it if you are unfamiliar with the disease.

Improving working conditions, combating environmental pollution, and avoiding contact with sick people are also prevention-oriented measures.

For effective treatment and preventive measures, anti-tuberculosis drugs are used - specific antibacterial agents intended for chemotherapy in patients with consumption.

Classification of funds

For various forms of the pathological process, drugs for pulmonary tuberculosis are used, which have a high bacteriostatic effect against the causative agent of the disease.

Anti-tuberculosis drugs are divided into 3 groups: A, B, C. In many cases, first-line (main) substances are prescribed for therapy:

• Rifampicin;
• Pyrazinamide;
• Isoniazid;
• Ethambutol;
• Streptomycin.

If resistant forms of the tuberculosis pathogen appear and there is no effect of treatment, the patient is prescribed second-line (reserve) drugs:

• Ethionamide;
• Cycloserine;
• Amikacin;
• Capreomycin.

• Ofloxacin;
• Levofloxacin.

If the disease has gone too far, it is advisable to include bacteriostatic agents in the list of necessary means:

• Ethionamide;
• Terizidone.

Group 5 of drugs includes drugs with unproven activity:

• Amoxiclav;
• Clarithromycin;
• Linezolid.

It is necessary to follow certain rules when prescribing anti-tuberculosis drugs - the classification of drugs makes it easier to select the necessary drugs.

After diagnosis, taking into account the symptoms of the disease, the patient is registered at the dispensary. In the first accounting group, patients with an active form of tuberculosis are observed and treated.

There are several subgroups in which there are patients with destructive pulmonary tuberculosis who release bacteria into the environment. The chronic course of the disease of any localization is subject to careful monitoring and treatment, especially in the case of the development of cavernous and cirrhotic processes. After chemotherapy, residual changes in the lung tissue remain. Patients are under medical supervision.

A fairly common occurrence is human contact with a source of tuberculosis infection. The patient must regularly visit the doctor to identify the primary infection. Children and adolescents with a tuberculin test are regularly examined by a TB specialist.

Treatment of lung disease is carried out in compliance with the basic principles:

• early use of effective chemotherapy;
• complex use of drugs;
• prescribing medications taking into account the characteristics of the pathogen;
• regular monitoring of the therapy process.

The patient is prescribed specific, pathogenetic and symptomatic treatment.

Vital medications

Tuberculosis tablets destroy sensitive mycobacteria, so they are used in the intensive care phase to stop the release of the pathogen into the environment. First-line drugs are prescribed to be taken for 2 months (at least 60 daily doses) for patients who are newly diagnosed with tuberculosis.

For treatment, 4 drugs are prescribed:

• Isoniazid;
• Rifampicin;
• Pyrazinamide;
• Ethambutol.

In an HIV-infected patient, Rifampicin is replaced with Rifabutin. To continue therapy for several months, the main drugs for the treatment of tuberculosis are prescribed - Isoniazid and Rifampicin. Often the patient is recommended to take 3 first-line drugs against tuberculosis - Isoniazid, Pyrazinamide and Ethambutol. The course of therapy lasts 5 months.

The tuberculosis treatment regimen is recommended for patients who have interrupted therapy or are undergoing a repeat course. If resistance of the tuberculosis pathogen is diagnosed, daily doses of drugs are prescribed in 1 dose to establish their high concentration in the blood serum.

The anti-tuberculosis drug Pyrazinamide is prescribed to the patient if there are contraindications to the use of Ethambutol. The dose of the medication is determined taking into account the age and weight of the patient; Children and adolescents are prescribed the drug for medical reasons.

Combined products: advantages and disadvantages

Treatment of pulmonary tuberculosis in adults is carried out with the help of medications designed to control their intake and prevent overdose. Combined anti-tuberculosis drugs include 3-5 components.

The following medications are used in outpatient practice:

• Rifinag;
• Phthisoetam;
• Rimcourt;
• Prothiocomb.

The main components of the combined drugs are isoniazid, ethambutol, vitamin B6. The medicine Lomecomb consists of 5 ingredients that influence the course of the acute process.

Combined drugs are prescribed to patients with tuberculosis diagnosed for the first time, as well as with severe resistance to isoniazid and rifampicin.

In the tuberculosis dispensary, therapy is carried out using the drugs Lomecomb and Protiocomb, which increase the effectiveness of treatment in the event of a progressive form of the disease. The main disadvantage of combined substances is the presence of side effects.

Reserve medicines

If it is not possible to achieve the effect of treatment with first-line drugs, the patient is prescribed backup drugs:

• Cycloserine;
• Ethionamide;
• Kanamycin;
• PASK.

Their use gives good results in the treatment of the disease.

For the treatment of resistant dosage forms, Levofloxacin from the group of fluoroquinolones is used. The daily dose is set individually for each patient, taking into account the pharmacokinetics of the drug. If the patient does not tolerate Levofloxacin well, Avelox is prescribed, an antibiotic that has a universal effect.

Treatment of the intensive phase of pulmonary tuberculosis is carried out using combined drugs that cause the development of side effects. Levofloxacin is prescribed simultaneously with medications that eliminate its side effects on the nervous system.

PAS has a negative effect on the stomach and intestines. The patient is recommended to take the medicine with water mixed with cranberry juice. Taking PAS is discontinued if the patient develops joint pain.

Side effect

The doctor monitors concomitant reactions during treatment with chemicals. The patient is prescribed blood and urine tests, ALT and AST in the blood are determined, the presence of creatinine is determined, and a doctor’s examination is recommended during treatment with aminoglycosides.

Side effects of anti-tuberculosis drugs are manifested by unpleasant symptoms. Isoniazid causes headache, irritability, and insomnia. The patient's optic nerve is affected, palpitations, heart pain, and symptoms of angina pectoris occur. Rifampicin (Ref) is difficult to tolerate by patients, because causes serious complications from the nervous system:

• visual impairment;
• unsteady gait;
• lack of correct orientation in space.

Often the patient develops an allergic reaction, accompanied by muscle pain, weakness, herpetic rashes, and fever.

Therapy with anti-tuberculosis drugs has a negative effect on the digestive system. The patient complains of nausea, vomiting, pain in the stomach and liver. Kanamycin sulfate causes dyspeptic disorders, neuritis and the appearance of blood in the urine.

How to take medications

To treat pulmonary tuberculosis, a specific therapy regimen is prescribed. The medicine is taken in the dose recommended by the doctor, taking into account the stage of development of the disease.

The treatment regimen includes substances that enhance the effect of anti-tuberculosis drugs, for example, glutamyl-cysteinyl-glycine disodium. Patients with HIV infection receive therapy for 9-12 months.

Levofloxacin is prescribed if the causative agent of the disease is resistant to drugs of the main group. The antibiotic is taken continuously for 24 months. It has a bactericidal effect, but is not recommended for patients with kidney disease. The medicine is non-toxic, so patients tolerate it well.

For the treatment of adults, aminoglycosides are prescribed in combination with penicillins. Amikacin is administered intramuscularly, intravenously. The doctor prescribes the dose of the drug individually. During treatment, the patient is given plenty of fluids to drink. Amikacin should not be mixed with other drugs.

Patients with diabetes when treated with Rifampicin and Isoniazid should monitor blood glucose levels.

PASK tablets are taken according to the instructions, washed down with milk or alkaline mineral water. Fraction ASD 2 is recommended for patients with severe tuberculosis.

Therapy with Dorogov's stimulant

If resistance to 1st and 2nd line drugs has developed, some patients use unconventional methods of treatment. For pulmonary tuberculosis, the drug ASD has proven itself to be an antiseptic and stimulant that restores the cells of the diseased organ and the immune system.

Treatment with the ASD fraction improves lung function, increases the number of enzymes and restores the permeability of the cell membrane. As a result of the action of the drug, metabolism in the tissues of the diseased organ is activated. The medicine has an unpleasant odor, so before taking it it is mixed with juice or kefir.

Pulmonary tuberculosis in adults and children is treated according to a specific regimen. The dose of the drug is prescribed by the doctor. The duration of therapy does not exceed 3 months. In some cases, the patient develops an allergic reaction; in patients with unstable mental health, uncontrollable agitation occurs. In this case, the drug is discontinued.

The fraction is contraindicated for pregnant and nursing mothers. Modern pharmacology considers ASD as a natural complex, similar in structure to the substances that make up the human body.

New drugs

Among the best drugs is the effective drug SQ109, used to treat patients with pulmonary tuberculosis. After using it for 6 months, it is possible to stop the release of the pathogen into the environment. The medicine is safe and well tolerated by patients. SQ 109 is prescribed for combination therapy in combination with Isoniazid, Bedaquiline and Ampicillin.

New anti-tuberculosis drugs belong to the 2nd line drugs and have an antibacterial effect. The patient is prescribed medications:

• Bedaquiline;
• Linezolid;
• Sparfloxacin;
• Ethionamide.

New anti-tuberculosis drugs help to successfully combat primary or secondary drug resistance of Mycobacterium tuberculosis. Among the new drugs for tuberculosis, the drugs BPaMZ and BPaL, used for the treatment of tuberculosis of various localizations, have an effective effect. The drug BPaL is used to treat illness caused by resistant forms of the pathogen.

New drugs against tuberculosis are undergoing clinical trials and significantly reducing the duration of therapy. The drug Prothiocomb reduces the number of tablets needed to take during the day several times, and its effectiveness is not inferior to the effect of single drugs.

Alcohol compatibility

Patients who abuse alcohol often develop tuberculosis. Treatment for a drinker is lengthy and accompanied by severe complications. For alcohol dependence, a patient with tuberculosis is prescribed drugs such as:

• Streptomycin;
• PASK;
• Rifampicin.

If during treatment the patient allows himself a small dose of alcohol, gastritis often develops after taking the medicine, increasing the load on the liver.

Amikacin in combination with alcohol causes nausea and vomiting. Symptoms of depression of the nervous system occur after simultaneous use of the antibacterial drug Amikacin and strong alcoholic beverages. A bad habit and unauthorized cessation of treatment often lead to a decrease in the body’s defenses and the development of the cavernous form of tuberculosis.

The combination of the following drugs with alcohol is extremely dangerous: Rifadina, Isoniazid, Ethionamide. After drinking small doses of alcohol, the patient develops symptoms of acute hepatitis. The simultaneous use of anti-tuberculosis drugs and alcohol disrupts the function of the pancreas and increases inflammation of the respiratory tract.

Contraindications for use

Anti-tuberculosis drugs do not always benefit the patient. Isoniazid is not prescribed to patients with liver disease, epilepsy and reactive psychosis. PAS causes exacerbation of gastric and duodenal ulcers, glomerulonephritis, nephrosis, hypothyroidism.

In the vast majority of cases, Amikacin is not recommended for patients suffering from pathologies of the organs of vision and hearing, or renal failure.

Sometimes patients complain of an allergic reaction during treatment with anti-tuberculosis drugs.

• Tavegil;
• Diazolin;
• Zaditen.

Ciprofloxacin is not prescribed to elderly people, pregnant women, or those with hypersensitivity to the drug. In tuberculosis dispensaries, infusion therapy begins with a jet injection of an antibiotic.

• thrombophlebitis;
• hypertension of II and III degrees;
• diabetes mellitus;
• hemorrhagic diathesis;
• circulatory failure of II and III degrees.

During breastfeeding, taking Rifampicin and medications from the fluoroquinolone group is contraindicated.

Preventive action

A patient takes pills to prevent tuberculosis. Streptomycin is prescribed to pregnant women, patients suffering from pathologies of the brain, kidneys, and heart. Tuberculosis is prevented in children and adults using the drug Metazide. The drug has a bactericidal effect, but sometimes causes side effects:

• dizziness;
• nausea;
• vomiting;
• diarrhea;
• allergic reaction.

The medicine is taken simultaneously with vitamins B1 and B6. The drug is contraindicated in patients with diseases of the nervous system.

Prevention of tuberculosis in adults is carried out using a broad-spectrum antibiotic. Cycloserine is taken as prescribed by a doctor. The medicine is contraindicated for people with mental disorders who abuse alcohol.

A drinking patient experiences headache, tremors, disorientation, and increased irritability. When taking an antibiotic, you must be careful because... the patient may experience seizures. In this case, the patient is prescribed sedatives and anticonvulsants.

The success of treatment of pulmonary tuberculosis depends on the exact implementation of the doctor’s recommendations and adherence to the treatment regimen.

Infection with the tuberculosis bacillus most often leads to disorders in the pulmonary system. Timely detection of pathology and the prescription of a therapeutic course can stop the further development of the disease and increase the body's resistance to infection. Treatment of pulmonary tuberculosis in adults is often long-term and may require up to several months of persistent therapy.

Causes

The main reason for the development of tuberculosis is the penetration into the body and subsequent activation of acid-fast mycobacteria (Koch bacilli). These microbes have been known to mankind for centuries and are extremely resilient and resistant to drug therapy.

Tuberculosis can also be caused by other microorganisms, including Mycobacterium tuberculosis, Mycobacterium africanum, Mycobacterium bovis, Mycobacterium pinnipedii, Mycobacterium bovis BCG and others.

It is widely known that tuberculosis infection most often occurs through airborne droplets. Pathogens can also enter the human body through nutrition (by consuming products that have had contact with a patient with open form of tuberculosis), intrauterine (the fetus is affected by an infected mother), contact (in this case, the infectious agent enters the body of a healthy person through mucous membranes or microdamages on the skin).

Certain segments of the population are especially susceptible to infection with tuberculosis. These categories include the poor, the homeless, people in prison, people suffering from immune disorders, diabetes, and chronic diseases of the respiratory system. Mycobacterium infection also occurs in health care workers who do not take increased precautions when working with tuberculosis patients.

Symptoms of pulmonary tuberculosis in adults

The first signs of mycobacteria infection are in many ways similar to a common cold. The patient has symptoms such as:

1. Increased body temperature to subfebrile levels (from 37 to 37.5 °C).
2. Dry cough.
3. Body aches.
4. Runny nose, nasal congestion.
5. Chills.
6. Sleep disorders.
7. Increased sweating.
8. Increase in the size of lymph nodes.

Such symptoms can be present individually or combined in various variations.

The main clinical signs of tuberculosis appear as the disease progresses. The initial symptoms are supplemented by:

• a change in the patient’s appearance – the face becomes unhealthy thin and pale, the features become sharper, the cheeks become hollow, and a painful shine appears in the eyes;
• rapid weight loss while maintaining the usual appetite;
• an increase in hyperthermia in the evenings (t reaches 38 degrees or more, and subsides in the morning);
• constant cough, changing from dry to wet;
• pain in the chest, between the shoulder blades, intensifying with inspiration.

Coughing with sputum and bloody spots is observed when the disease passes into the infiltrative form. If blood is released in the form of a fountain, such a sign indicates a rupture of the cavity.

Diagnosis of the disease

The main methods for diagnosing a dangerous disease are:

• clinical examination, consisting of studying the condition of the lymph nodes, range of motion of the sternum, listening to the lungs and bronchi;
• chest x-ray;
• bacterioscopic examination of sputum for the presence of tuberculosis pathogens;
• blood test.

In some cases, the patient undergoing examination is prescribed a computed tomography (CT) scan and bronchoscopy.

The development of tuberculosis infection in children is indicated by a positive reaction to the Mantoux or Diaskintest test.

Treatment of pulmonary tuberculosis

Treatment of tuberculosis traditionally requires a considerable period of time - from 3 months to 2 years. The open form of the disease requires mandatory placement of the patient in a hospital. With a closed type of pathology, therapy is carried out on an outpatient basis.

The main method of treatment is taking special medications. If there are appropriate indications, surgery is prescribed.

The patient’s stay in a sanatorium allows the patient to stay in a sanatorium to consolidate the results of the treatment course. Treatment abroad based on the use of new medical technologies is considered highly effective.

Treatment in the early stages

The fight against the disease at an early stage consists of prescribing to the patient:

1. Antibiotics.
2. General strengthening drugs.
3. Immunomodulators.
4. Physiotherapy.

At the initial stage of pathology, aerosol antimicrobial therapy, which has a preventive effect and prevents further activation of pathogenic bacteria, becomes relevant. Taking vitamin complexes contributes to the overall strengthening of the body and increasing its resistance to infection. The administration of immunomodulators helps reduce the period of intoxication, increase the protective function, regression of the tuberculosis process, and reduce the frequency and severity of side effects of chemotherapy.

A significant improvement in the condition of lung damage can be achieved through electrophoresis and collapse therapy. It is allowed to begin such physical treatment only during the period of remission and while undergoing a rehabilitation course.

Traditional medicine methods help to enhance the effectiveness of basic therapy for tuberculosis at an early stage. A good addition to antimicrobial and supportive medications is the use of milk with rendered bear lard, a decoction of marshmallow roots, and badger fat with honey.

Medicines

The selection of medications and determination of dosages is carried out on an individual basis. At the beginning of anti-tuberculosis therapy, drugs of first choice are used. The patient is prescribed a course:

• Ethambutol;
• Rifampicin;
• Streptomycin;
• Isoniazid;
• Pyrazinamide.

In case of an increased likelihood of the disease progressing to the next stage, it is planned to include Ofloxacin, Levofloxacin, Ethionamide, Lomefloxacin in the main regimen.

Among vitamin complexes, the choice is made in favor of drugs saturated with vitamins A, C, group B, E and D. Among the immunomodulators for tuberculosis, Leukinferon, Imunofan, Polyoxidonium, Glutoxim, Lykopid are effective.

The elevated temperature characteristic of the disease only goes down if it reaches 38.5-39 degrees. In such situations, ibuprofen drugs or Paracetamol are used.

Treatment in hospital

The length of stay of a patient with open tuberculosis in hospital is determined:

• severity and stage of the infectious process;
• the level of resistance of the body to the disease;
• existing complications such as emphysema, pulmonary hemorrhage, heart or pulmonary failure;
• the presence of contraindications to the medication course.

The degree of damage to the lungs or other organs is also taken into account (in the second case we are talking about secondary tuberculosis).

Placing a patient in a hospital is necessary to carry out the most accurate diagnosis, monitor all stages of the treatment course, and provide immediate medical care in case of complications. Keeping the patient under constant medical supervision makes it possible to take timely necessary measures in the event of the disease spreading beyond the lungs and to carry out urgent operations.

The course of treatment in a hospital setting takes at least 2 months. After the patient ceases to pose a danger to others, measures are taken to restore the body. To do this, the patient is sent to a tuberculosis dispensary or a specially equipped sanatorium. Also, consolidation of the course in an adult or child can be carried out at the place of residence (outpatient treatment).

A course of chemotherapy using anti-tuberculosis drugs becomes the basis for the treatment of a dangerous disease. The drugs used are often combined with each other - thanks to this, it is possible to avoid addiction to the active substances from the causative agent of the disease.

In the case of a correctly selected treatment regimen, on days 20-25 the process of abacillation of the patient is observed - the cessation of the release of pathogens into the sputum. At this stage, the decay of lung tissue stops, and the patient is no longer infectious.

The first course of therapy is completed after 2-3 months. During this period, the patient may be discontinued some medications. Basic antimicrobial agents, such as Rifampicin and Isoniazid, are taken for another 4-6 months. While in the hospital, the patient periodically takes blood and sputum tests, which are necessary to monitor his condition and the dynamics of the treatment.

Many anti-TB drugs are highly toxic and can cause severe side effects. To avoid deterioration of the patient's general condition, constant medical supervision is required. If medications are poorly tolerated, the doctor makes adjustments to the implemented therapeutic regimen.

Operation

Indications for surgery in a patient with tuberculosis are:

1. Low effectiveness of chemotherapy.
2. The presence of complications and critical consequences of the disease (bleeding in the lungs, spontaneous pneumothorax).
3. The presence of morphological changes, which cannot be avoided.

Surgical treatment helps restore the activity of the pulmonary parenchyma, remove accumulations of fluid and sputum, and eliminate congenital or acquired anatomical anomalies. More often, planned operations are performed for tuberculosis. Sometimes there is a need for emergency intervention (in cases of rapid development of pathology, a sharp deterioration in health, or risk of death of the patient).

The main types of surgical intervention are:

• lobectomy (resection of the pulmonary lobe);
• pneumectomy (complete removal of the lung);
• thoracoplasty (minimally invasive type of surgery).

Before and after surgical treatment, an intensive course of chemotherapy is required to ensure stabilization of the patient's condition.

Spa treatment

Sanatoriums for the recovery of patients who have suffered severe lung pathology are traditionally located in coastal, mountain, steppe, and forest-steppe zones. It provides for comprehensive treatment of tuberculosis in combination with climatic and physical factors.

Patients are prescribed:

1. Chemotherapy.
2. Inhalations.
3. Air baths.
4. Breathing exercises.
5. Heliotherapy.
6. Climatotherapy.
7. Treatment of concomitant diseases.

Treatment in sanatorium-resort conditions is especially indicated in the presence of focal, disseminated, infiltrative tuberculosis, which has passed into the resorption phase, scarring of the lung tissue. Also, postoperative patients, persons who have completed the main course of therapy for tuberculoma, cavernous and fibrous-cavernous forms of the disease, and tuberculous pleurisy are sent to such institutions.

Treatment of tuberculosis abroad

Tuberculosis treatment abroad is carried out in accordance with all modern standards. Most often, the patient manages to completely get rid of the infection and undergo an effective recovery course.

Tuberculosis treatment is provided with high quality in Germany, Belgium, and Switzerland. The fight against the disease in these countries is based on the principle of an individual approach to each patient, the use of traditional and new drugs, and performing the safest surgical operations. A significant role is given to rehabilitation, including cryotherapy, massages, electrotherapy, iontophoresis, and the appointment of a special diet.