Antituberculosis drugs

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and characterized by the development of cellular allergies, specific granulomas in various organs and tissues and polymorphic clinical picture. Mycobacterium tuberculosis, or Koch's bacillus usually affects lungs, lymphatic system, bones, joints, genito-urinary organs, skin, eyes, nervous system. Left untreated, the disease progresses and ends fatally.

Activity against M.tuberculosis has a large number of drugs which differ in origin, chemical structure and mechanism of action.

Classification of anti-TB drugs of the International Union Against Tuberculosis and Lung Disease:
I Group (preparations of high efficiency):
Isoniazid, Rifampicin
II Group (moderate efficiency):
Streptomycin, Kanamycin, Viomycin, Cycloserine, Ethambutol, Ethionamide, Protionamide, Pyrazinamide
III Group (low efficiency):
Aminosalicylic acid, Thioacetazone

Methods of treatment of tuberculosis

  1. Chemotherapy
  2. Medicinal therapy with anti-inflammatory drugs, hormones and vitamins and symptomatic treatment
  3. Dietary and health resort treatment
  4. Collapsotherapy, surgical treatment in combination with chemotherapy.

The main method of TB treatment is chemotherapy. Modern TB drugs are successful in all the forms if the disease providing a lasting recovery for the vast majority of patients. Treatment should be complex, long-term, continuous, and phased. The complex treatment involves the simultaneous administration of two to four chemotherapeutic drugs to influence bacteria with different resistance and to prevent drug resistance in mycobacteria.

The duration of the primary treatment of the newly diagnosed is 9-12 months (in the early stages of TB it can be reduced to 8 months). Continuity of receiving chemotherapeutic agents for the main course of treatment is needed to suppress the ability of mycobacteria to reproduce. The main course of chemotherapy can be divided into two phases: intensive treatment in a hospital for the quick elimination of acute manifestations of the disease and a treatment in a sanatorium followed by ambulatory therapy. For each patient, depending on the clinical manifestations of the process prevalence, should be selected the appropriate treatment regimen. It can be changed if drug resistance of mycobacteria to a particular drug is detected or if adverse reactions are not eliminated.

In addition, to suppress inflammation, the treatment may include:

  • immunostimulating agents (levamisole, ethimizol, methyluracil, etc.)
  • agents which prevent the development of connective tissue, i.e. hardening in the process (pyrogenalum, hyaluronidase, prednisolone)
  • antioxidants (tocopherol, sodium thiosulfate)

In addition, in the treatment of tuberculosis are used antiallergic drugs, vitamins and other symptomatic agents: antipyretics, expectorants, medicines to improving the function of the cardiovascular system, styptic, oxygen therapy, and others.

An intermediate position between the therapeutic and surgical methods of treatment belongs to the so-called collapse therapy: the introduction of air into the pleural cavity (artificial pneumothorax) and the abdominal cavity (pneumoperitoneum). Collapse therapy is used to treat patients with severe infiltrative changes in the lungs and cavities, pulmonary hemorrhage and hemoptysis, in case of drug resistance of Mycobacteria.

Surgical treatment of tuberculosis is used with restrictions due to inability to quickly remove all foci. Surgical intervention is usually used in the fibrocavernous pulmonary tuberculosis, less often - in tuberculoma. Children undergo removal of isolated and multiple caseous necrotic intrathoracic lymph nodes. For the treatment of patients with extrapulmonary localizations of tuberculosis, it is used preserving resection of the diseased organ and removal of the caverns and sequesters (dead bone tissue). © 2020