Question

Antitubercular Therapy:

1. What medications are the first line treatment?
2. What is the time frame for medication therapy with an active case of TB?
3. What does this have to do with direct observation therapy and adherence?

Answer 1

For initial empiric treatment of TB, start patients on a 4-drug regimen: isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin. Once the TB isolate is known to be fully susceptible, ethambutol (or streptomycin, if it is used as a fourth drug) can be discontinued.

Medications are the cornerstone of tuberculosis treatment. But treating TB takes much longer than treating other types of bacterial infections.

Foractive tuberculosis, you must take antibiotics for at least six to nine months. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance and the infection's location in the body.

More than twenty drugs have been developed for the treatment of TB. Most of them were developed some years ago. You can read about the History of TB Drugs.

The anti tubercular drugs are used in different combinations in different circumstances. For example some anti TB drugs, the first line drugs, are only used for the treatment of new patients who are very unlikely to have resistance to any of the TB drugs. There are other TB drugs, the second line drugs, that are only used for the treatment of drug resistant TB.1 There are now starting to be some new TB drugs, but most are still undergoing testing.

Generally anti TB drugs, that is TB medicine, is taken for the treatment of active TB or TB disease. One exception to this is when TB drugs are taken for the treatment of latent TB.

One TB drug must never be taken on it’s own. Several TB drugs, or TB medication, must always be taken together. If only one TB drug is taken then resistance may develop to the drug. This means that the drug won’t work and the patient isn’t cured of TB.It is often now that several TB drugs are combined together in one tablet or pill. This is known as a FDC, or Fixed Dose Combination.

All patients should be monitored to assess their response to therapy . Regular monitoring of patients also facilitates treatment completion and allows the identification and management of adverse drug reactions. All patients, their treatment supporters and health workers should be instructed to report the persistence or reappearance of symptoms of TB (including weight loss), symptoms of adverse drug reactions, or treatment interruptions.

Patient weight should be monitored each month, and dosages should be adjusted if weight changes. Additional monitoring and the actions it triggers are discussed below for pulmonary and extrapulmonary cases treated with first-line drugs.

A written record of all medications given, bacteriological response and adverse reactions should be maintained for every patients on the TB Treatment Card.

The programme should carefully review the quality of the patient's support and supervision and intervene promptly if necessary. Patient treatment records should be reviewed with the responsible health care worker, and reasons for any interruptions should be explored and addressed (.

It is unnecessary, unreliable and wasteful of resources to monitor the patient by chest radiography.