DIAGNOSIS OF TUBERCULOSIS
Sputum microscopy: Sputum microscopy is the most
efficient way of identification of tuberculosis infection. In areas with high
prevalence of tuberculosis, microscopic examination of smear should be initial
test.
Culture: Mycobacterium culture is useful for the
definitive confirmation of tuberculosis and in drug sensitivity determination. Its
role becomes important with declining prevalence of tuberculosis in a
community. The Lowenstein Jensen medium is the commonest culture medium to use
and is most often combined with sputum microscopy (Booker, 1996).
TREATMENT OF TUBERCULOSIS
Treatment for TB uses antibiotics to kill the bacteria. The
two most commonly used are Rifampicin and Isoniazid. However, instead of the
short course of antibiotics typically used to cure other bacterial infection,
TB requires much longer periods of treatment around (6-12 months) to entirely
eliminate mycobacteria from the body. (Centers for disease control).
The aims of TB treatment
include:
1. To decrease mortality, long
term morbidity and transmission
2. To affect a permanent cure, prevent
relapse and decrease transmission.
3. To achieve the above with minimum
side effect.
4. To minimize the development of
drug resistance.
Drug
used in anti- tuberculosis treatment:
First line drugs include
·
Isoniazid
(H)
·
Rifampicin
(R)
·
Pyrazinamide
(Z)
·
Ethambutol
(E)
·
Streptomycin
(S)
·
Thiacetazone
(T)
Second
line drugs
These are those drugs which should be reserved for
use in drug- resistant cases only. e.g Ethionamide and prothinanamide .
Treatment of tuberculosis is in two phases:-
Intensive and Continuation phases.
Intenssive phase entails,
1. Rapid killing of bacteria,
resulting in
2. A state of non- infectiousness
within 2 weeks.
Multiple drugs are combined in
intensive phase.
Continuation phase lasts for 6
months using fewer drugs for longer time to eliminate the remaining bacilli.
F.
Directly observed treatment short course (DOTS)
DOTS is a strategy to ensure cure by providing the
most effective medicine and confirming that it is taken. It was adopted in
1993 by the WHO and is the only strategy
which has been documented to be
effective world wide on a program basis. In Dots during the intensive phase of
treatment a health worker or other trained person watches as the patient
swallows the drug in his presence. During continuation phase the patient is
issued medicine for one week in a multi blister combipack of which the first
dose is swallowed by the patient in the presence of health worker or trained
person. The consumption of medicine in the continuation phase is also checked
by return of empty multiblister combipack when the patient comes to collect
medicine for the next week.
The whole idea is to ensure compliance by monitoring the
patient. Treatment of TB lasts long and the early arrest of the bacilli in the
first 2 months is important to avoid drug resistance (K.Parks. pg 146).