Tuberculosis: Treatment and Vaccination

Cures and treatments

Like all diseases caused by bacteria, tuberculosis can also be effectively treated with antibiotic drugs, which aim to completely destroy the bacterial population. However, drug therapy must be continued much longer than normal treatments. The patient with tuberculosis, in fact, must take antibiotics for a period of at least 6-9 months. This period of time, as well as the type of medicines used in the various phases, is carefully calculated by the doctor on the basis of the age, the general state of health of the patient, the severity and location of the disease, as well as the degree of resistance of the bacterial strain to the various medicines.

Latent Tuberculosis

The specialist who is treating a tuberculosis patient in latent form can opt for a preventive chemoprophylaxis treatment, with the aim of destroying inactive bacteria, eliminating the risk of future evolution of the disease in the very dangerous active form. In young children and HIV-infected people, this precaution is particularly important. For this purpose, a single drug (isoniazid TB) is usually given in daily or biweekly doses for a period that is generally around nine months.

Active Tuberculosis

Those affected by the active form of tuberculosis are promptly subjected to multi-drug therapy, generally based on four drugs: rifampicin, ethambutol (or streptomycin), isoniazid and pyrazinamide. This "cocktail" can vary over time if the chosen combination does not have the desired therapeutic effect. The various active ingredients can sometimes be combined within a single pill (rifapentine), which improves patient compliance without negatively affecting the patient's compliance. "therapeutic effect.

Side effects

ANTITUBERCULAR DRUGS
FIRST CHOICE ANTITUBERCULAR DRUGS
SECOND CHOICE

ISONIAZIDE

RIFAMPICINA

STREPTOMYCIN

RIFABUTINA

ETAMBUTOL

PYRAZINAMIDE

Cycloserine

Etionamide

Levofloxacin

Moxifloxacin

Ciprofloxacin

Gatifloxacin

Paraminosalicylic acid

Amikacin

Kanamycin

Capreomycin

For further information: Drugs for the treatment of Tuberculosis

The treatment, being so prolonged, is not free from side effects, such as the risk of developing liver disease and hepatitis; the blood values that reflect the function of the organ (eg transaminases) are therefore carefully monitored throughout the duration of the disease. For the same reason it is recommended to limit the use and abuse of alcohol, as well as drugs to paracetamol (acetaminophen) base throughout the course of treatment Rifampicin can also cause severe flu-like symptoms, such as fever, chills, body aches, nausea and vomiting.

During treatment, the patient should therefore promptly report the appearance of symptoms such as nausea, vomiting, loss of appetite, dark urine, yellowish skin (jaundice), fever that has persisted for three or more days without an obvious reason, abdominal swelling and blurred vision.

Antibiotic Resistant Tuberculosis

Alongside first-choice drugs, there are other specialties intended for the treatment of patients suffering from multidrug-resistant or poly-resistant tuberculosis. The socio-economic cost of such a treatment is particularly high, both for the long duration of the therapy - which goes from 18 months to more than 2 years - and for the high economic resources necessary for the "purchase of the" cocktail ", and for the major side effects.

Precisely because of the high resistance of the bacilli, the chances of survival are lower and even in the case of therapeutic success it may be necessary to perform a small surgery to remove the areas where the infection is still active or repair the lung damage caused by the illness. Equally complicated is the treatment of HIV-positive patients affected by active tuberculosis, as some drugs used in the treatment of AIDS (antiretroviral therapy) interact with antibiotics intended for the treatment of tuberculosis, decreasing the effectiveness of both therapies.

The likelihood of therapeutic success depends on the extent of resistance of the bacterial strain, the severity of the disease and the level of impairment of the patient's immune system.

Why It Is Important To Complete The Treatment

Whatever treatment is undertaken, it is essential to complete the therapeutic cycle, in full compliance with the medical prescription. After a few weeks from the start of treatment, most patients are no longer contagious and feel better. The newfound well-being can lead to premature discontinuation of antibiotic therapy; such behavior must be absolutely condemned, as it facilitates the selection of resistant strains putting at risk the health of the individual and of the whole community. The same dramatic result is obtained by using low quality medicines or following an inadequate treatment protocol.

To stem the spread of resistant strains, a protocol was developed, the so-called DOT strategy (directly observed therapy). This approach provides for continuous assistance by a nurse or other healthcare professional, who constantly monitors the progression of the disease, the regularity of drug intake, as well as the effects and effectiveness of the same.

Vaccine against tuberculosis

Tuberculosis vaccination is now mandatory in various countries around the world. Currently, the only preparation available is BCG (bacillus of Calmette Guérin), which is attributed an efficacy close to 80% in the prevention of severe childhood diseases. However, the protection conferred by this vaccine is maximum against children residing in highly endemic areas, while it decreases in areas where mycobacteria are less prevalent; it is also ineffective in adulthood. Given the dramatic spread of tuberculosis globally, several vaccines have been studied and developed in recent years, which are currently still in an experimental phase.