Tuberculosis treatment

Tuberculosis treatment refers to the medical management of tuberculosis (TB), a highly infectious disease primarily affecting the lungs but capable of involving multiple organ systems. The treatment of TB is critical not only for the health of the infected individual but also for public health at large, due to the contagious nature of the disease.

Overview

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. It spreads through airborne particles when people with active pulmonary TB cough, sneeze, or spit. The cornerstone of TB treatment is a lengthy course of multiple antibiotics to ensure the complete eradication of the bacteria. Treatment is complicated by the emergence of multi-drug resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), which do not respond to standard antibiotics.

Treatment Regimen

The typical treatment for uncomplicated, drug-sensitive TB involves a two-phase approach:

• Initial phase: A combination of four antibiotics: isoniazid, rifampicin, pyrazinamide, and ethambutol for two months.
• Continuation phase: The number of drugs is reduced, usually to isoniazid and rifampicin, and the treatment is continued for a further four to six months.

For MDR-TB and XDR-TB, the treatment involves a longer duration and a combination of second-line drugs, which can be more toxic and less effective than the first-line drugs.

Directly Observed Therapy (DOT)=

To improve treatment adherence and prevent the development of drug resistance, the World Health Organization (WHO) recommends the Directly Observed Therapy, Short-course (DOTS) strategy. Under DOTS, a healthcare provider or trained volunteer directly observes the patient taking each dose of the prescribed drugs.

Challenges

Challenges in TB treatment include:

• Drug resistance
• HIV co-infection
• Patient adherence to the lengthy treatment regimen
• Side effects of TB medications
• Access to quality healthcare in resource-limited settings

Prevention

Preventive treatment is also crucial and includes vaccination with the BCG vaccine and treatment of latent TB infection to prevent the progression to active disease.

Future Directions

Research is ongoing to develop new vaccines, shorter and less toxic treatment regimens, and novel drugs to combat drug-resistant TB.