In the treatment of tuberculosis patients, chemotherapy has been one of the leading places for about 70 years. However, doctors note a decrease in its effectiveness as a result of prolonged use of the same drugs in chemotherapy regimens for tuberculosis, since bacteria have become resistant to many drugs. It is noted that bacteria are resistant not only to a single drug, but also to their combinations. An alarming factor is the lack of new classes of anti-TB drugs. Despite the difficulties, millions of people with chemotherapy were able to get rid of the disease and start a healthy life.
Primary and backup anti-TB drugs
Since the advent of the first anti-TB drugs (PTP) in the 50s of the 20th century, until now, the following main medicines have been distinguished:
- "Streptomycin".
- Ethambutol.
- "Pyrazinamide."
- "Rifampicin."
- Isoniazid.
They are effective bactericidal drugs against Mycobacterium tuberculosis (MBT) with a minimal number of adverse events. They are used in the treatment of patients in whom pulmonary tuberculosis was first detected.
Reserve funds include:
- Kanamycin (Amikacin).
- "Cycloserine."
- "Capreomycin."
- Protionamide
- "Paraaminosalicylic acid."
- Fluoroquinolones.
These are less effective drugs of bacteriostatic action. They replace the main drugs in case of resistance to tuberculosis mycobacteria or in case of adverse reactions in the patient.
All patients with tuberculosis according to the 2001 classification are divided into two groups:
- Excreting Mycobacterium tuberculosis, which are resistant to major anti-TB drugs.
- Allocating MBT resistant to both primary and backup anti-TB drugs.
For patients of the first group, reserve drugs are used to treat the disease. The second group of patients with total resistance to all anti-TB drugs can remain constant distributors of infection due to inefficiency of drugs. The treatment of these patients is carried out according to a special scheme, which consists in the use of various combinations of drugs and in the appointment of high doses.
Chemotherapy for Pulmonary Tuberculosis
A prerequisite for chemotherapy is the appointment of several types of drugs at the same time. This is due to the rapid addiction of mycobacteria to one drug. Four or five drugs are usually used for treatment.
In pulmonary tuberculosis, a course of chemotherapy consists of two phases:
- Intensive - during this period, potent drugs are used that stop the reproduction of mycobacteria and the inflammatory process.
- Continuation phase - at this stage of treatment, funds are used to consolidate the achieved result and prevent relapse.
Both phases of therapy are equally important. Without fixing treatment, you can lose the results achieved.
What affects the success of chemotherapy
For treatment to be successful, the following conditions must be met:
- There should be at least four drugs in the chemotherapy regimen for tuberculosis at the same time.
- Continuous therapy. Violation of this rule contributes to the addiction of mycobacteria to the drug.
- Course duration. You need to take medicine for at least six months. Otherwise, relapses are possible.
- The alternation of inpatient, outpatient and spa treatment helps to achieve better results.
- Testing the effectiveness of therapy. If there are no positive results for three months, an adjustment to the treatment regimen is necessary.
- Responsibility of the patient. He is obliged to comply with the therapy regimen and to realize that this is very important not only for him, but also for other people.
Chemotherapy regimens
In the treatment of pulmonary tuberculosis at each stage, an individual approach to therapy is required. Officially, by order of the Russian Ministry of Health, four chemotherapy regimens have been approved. For each of them, a generally established combination of medicines is used, the conditions of use and the necessary dosage are agreed. They are divided into:
- Standard (include 3 modes).
- Customized.
Standard chemotherapy regimens for tuberculosis include:
- First.
- The second (subdivided into 2a and 2b).
- Third.
Individual mode is called the fourth. Standard modes involve the use of highly effective and popular means to immediately stop the growth of mycobacteria. After the end of the standard mode and obtaining the results of the analyzes, correction of therapy is carried out. After this, the patient switches to the fourth personal treatment regimen.
The first chemotherapy regimen
It is prescribed at the first call of the patient for medical help. Moreover, he may observe:
- Significant lung damage, but there is no tubercle bacillus in sputum.
- The lungs are slightly affected, but the bacillus is a secret.
During the intensive phase of treatment with chemotherapy for tuberculosis in regimen 1, the patient uses four main drugs for two months (a total of 60 doses). After completing the first part of the treatment, the patient is examined. If the pathogen is not detected, but there are foci of inflammation in the lungs, the patient begins the second phase of therapy, which lasts from 4 months to six months using two drugs from the main list. In general, treatment lasts from six months to a year, depending on the reaction of bacteria to the drug. Sometimes the patient has to switch to a personal chemotherapy regimen.
Second chemotherapy regimen
This chemotherapy regimen for tuberculosis is divided into two subspecies:
- 2A. It is prescribed to patients with relapse after the first regimen, with an erroneous selection of drugs, inconclusive treatment for 30 days and the risk of secondary resistance of mycobacteria to medicines. In each case, five antibiotics from the main list are used, which take two months. After that, “Streptomycin” is canceled and therapy is continued for another month. During the period of intensive treatment, the patient receives 90 doses of drugs and is examined. With abnormal modifications in the lungs, but the absence of bacteria in sputum, the fixing phase of treatment is used. It includes 150 doses of three drugs over five months. Having found Koch's sticks in the sputum, a correction is made to the chemotherapy regimen for tuberculosis - the agents that cause the adaptation of bacteria are replaced with reserve ones. The phase of intensive treatment is extended for two months. If mycobacteria become resistant to several drugs, they switch to a personal therapy regimen.
- 2B. Used for patients who are expected to have a high probability of the stability of the causative agent of tuberculosis to drugs. These include the homeless, people after imprisonment, living in disadvantaged areas for this disease, patients with open tuberculosis who have stopped treatment. During intensive treatment, it is recommended that these individuals, along with the three main ones, prescribe drugs from the reserve list. The next phase of treatment when adapting agents to the pathogen continues in personal mode.
Third treatment regimen
Chemotherapy regimen 3 for tuberculosis is performed for patients with mild tuberculosis, in which Koch's bacillus is not found in sputum. The intensive phase of therapy, including 4 main drugs, lasts two months, which is 60 doses.
If there is a deviation in the lungs after treatment, therapy is continued for another four months, using two drugs. During the treatment period, it is very important not to take a break between the phases of treatment. If the survey results are not ready, then the first phase is continued until they are completed. The lack of positive results is an occasion to switch to individual chemotherapy.
Fourth mode
Patients who secrete a significant number of drug-resistant Koch rods are given a fourth chemotherapy regimen for pulmonary tuberculosis. Patients are placed in special tuberculosis departments, where there is constant monitoring of medical personnel. Intensive therapy lasts more than six months with the use of five drugs, consisting of the main and reserve groups. After the first phase of treatment, the control x-ray should have positive changes in the respiratory system.
Supportive therapy begins after confirmation of the absence of Koch's bacillus in the analysis of sputum and positive dynamics of treatment.
Optimum Mode Selection
Successful tuberculosis treatment and chemotherapy are inextricably linked. In each case, the doctor selects an individual regimen according to which the patient will undergo treatment. The following facts are taken into account:
- The sensitivity of mycobacteria to the drugs used.
- The severity of the patient.
- Individual characteristics of the body.
- The dynamics of clinical indicators.
Having chosen the regimen, the doctor determines the treatment conditions. Since therapy has a long period, it is recommended to alternate inpatient treatment with outpatient and spa treatment.
Patient groups
In medicine, four groups of patients are distinguished by the nature of chemotherapy:
- First one. All patients who first became ill with tuberculosis belong to it, but went to the doctor when the illness reached a severe form. They need to undergo chemotherapy, consisting of four main drugs within six months. After this, treatment with two drugs is prescribed.
- The second one. This category includes patients with a relapse of the disease as a result of a poorly selected chemotherapy regimen. Five medicines are prescribed to a patient with tuberculosis, the duration of use of which is three months. To consolidate the effect, treatment is continued for six months with drugs from the reserve list.
- The third. This includes patients with damage to the lung parenchyma and spread of the infection outside the organ. For treatment, three main drugs are used for three months. Then the patient, as maintenance therapy, takes two drugs for another six months.
- Fourth. This group includes patients with a chronic form of the disease. Two drugs are prescribed for life-long use.
Multidrug Resistant Tuberculosis (PRTB)
PRTB is poorly treated with conventional chemotherapy regimens. Multidrug-resistant tuberculosis is a neglected form of the disease as a result of uncontrolled treatment. Mycobacteria develop addiction to drugs, so they become ineffective. The main risk group for the incidence of this form of tuberculosis includes:
- HIV infected
- Persons in closed prison facilities.
- Socially unprotected categories of the population.
- People without permanent residence.
For the most effective treatment of drug-resistant disease, the International Union against Tuberculosis offers shortened (two-stage) courses of combination chemotherapy under the supervision of medical personnel. At the first stage, in case of multiresistant tuberculosis, a chemotherapy regimen should be prescribed, including four to five anti-TB drugs for two to three months. As a result, the reproduction of mycobacteria is suppressed, and the development of drug resistance is reduced. In the second stage, less intensive chemotherapy is used, consisting of two to three drugs. The main task is to prevent the remaining mycobacteria from multiplying.
The effects of chemotherapy
In the treatment of pulmonary tuberculosis with chemotherapy, some patients experience various complications. Often they are expressed in the following forms:
- Allergy - redness of the skin, rashes, Quincke's edema, hyperthermia syndrome, anaphylactic shock is possible.
- Toxic reaction - expressed in disruption of the kidneys, liver and central nervous system.
In some patients, adverse reactions with different chemotherapy regimens for tuberculosis are expressed in a decrease in the susceptibility of the auditory and optic nerve, inflammation of the mucous membrane of the stomach and intestines. Most often, various complications are people of advanced age, people with chronic diseases, allergies. When conducting chemotherapy, patients are prescribed detoxification drugs, hepatoprotectors, vitamin complexes and other drugs that support the body. In addition, patients undergo rehabilitation courses in sanatoriums.
Conclusion
Chemotherapy is one of the leading methods of fighting tuberculosis. The whole difficulty lies in the fact that not all patients can undergo a standard treatment regimen completely. In the process of therapy, part of the drugs have to be canceled due to mycobacteria resistance to them or intolerance to their patients. At the initial stage (according to the latest data), it is customary to use standard chemotherapy regimens for tuberculosis using standard ones with their subsequent adjustment, which is done individually for each patient and depends on specific conditions.