Management of tuberculosis

Management of Tuberculosis

Diagram of tuberculosis drugs and their actions

The management of tuberculosis (TB) involves a combination of medical treatment, public health strategies, and supportive care. The primary goal is to cure the patient, prevent transmission, and reduce the incidence of drug-resistant TB. This article outlines the standard treatment regimens, the management of drug-resistant TB, and the role of public health interventions.

Standard Treatment Regimens

The standard treatment for active TB involves a combination of antibiotics over a period of at least six months. The most commonly used first-line anti-TB drugs are:

• 

  Structure of Isoniazid
  Isoniazid (INH): A bactericidal drug that inhibits the synthesis of mycolic acids, essential components of the mycobacterial cell wall.

• 

  Structure of Rifampicin
  Rifampicin (RIF): A bactericidal antibiotic that inhibits RNA synthesis by binding to the beta subunit of DNA-dependent RNA polymerase.

• 

  Structure of Ethambutol
  Ethambutol (EMB): A bacteriostatic agent that inhibits the synthesis of the mycobacterial cell wall by blocking arabinosyl transferases.

• 

  Structure of Pyrazinamide
  Pyrazinamide (PZA): A prodrug that is converted to its active form in acidic environments, disrupting mycobacterial cell membrane metabolism and transport functions.

• 

  Structure of Streptomycin
  Streptomycin (SM): An aminoglycoside antibiotic that inhibits protein synthesis by binding to the 30S subunit of the bacterial ribosome.

The initial phase of treatment typically lasts two months and includes all four drugs (INH, RIF, PZA, and EMB). This is followed by a continuation phase of four months with INH and RIF.

Management of Drug-Resistant TB

Drug-resistant TB, including multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), poses significant challenges. MDR-TB is resistant to at least isoniazid and rifampicin, while XDR-TB is resistant to these drugs plus any fluoroquinolone and at least one of the second-line injectable drugs.

Treatment of drug-resistant TB requires the use of second-line drugs, which are less effective, more toxic, and more expensive. The treatment duration is also longer, often extending to 18-24 months. Newer drugs such as bedaquiline and delamanid have been introduced to improve outcomes in drug-resistant TB cases.

Public Health Strategies

Public health strategies are crucial in the management of TB. These include:

• Directly Observed Therapy (DOT): Ensures adherence to treatment by having healthcare workers observe patients taking their medication.

• Contact Tracing and Screening: Identifies and tests individuals who have been in contact with TB patients to prevent further spread.

• Vaccination: The BCG vaccine is used in many countries to prevent severe forms of TB in children.

• Health Education: Increases awareness about TB transmission, symptoms, and the importance of completing treatment.

Supportive Care

Supportive care for TB patients includes nutritional support, management of comorbidities such as HIV/AIDS, and psychological support to address the stigma associated with the disease.

Related Pages

• Tuberculosis
• Multidrug-resistant tuberculosis
• Extensively drug-resistant tuberculosis
• BCG vaccine