6.1. Treatment of tuberculosis patients: Principles and methods


The purpose of treatment of the adult tuberculosis patients is the liquidation of clinical displays of tuberculosis and stable healing of tubercular lesions with restoration of work capacity and social status. The purpose of treatment of children suffering from tuberculosis is cure without residual lesions changes or with minimal changes. Among some patients, it is impossible to achieve these goals, and so there are objective limits of treatment. In these cases it is necessary at least to achieve prolongation of patient’s life, improvement of his status, whenever possible to terminate or reduce MBT expectoration, to preserve partial work capacity.

Criteria of efficiency of tuberculosis patients treatment are:

  1. disappearance of clinical and laboratory signs of tubercular inflammation;
  2. stable termination of MBT expectoration, confirmed by microscopic and cultural examinations;
  3. regress of radiographic signs of tuberculosis (focus, infiltrative, destructive);
  4. restoration of functional abilities and work capacity.

The features of tubercular process determine complexity of treatment of the patients. At this disease it is necessary rationally to combine various medical measures:

  1. antibacterial and anti-inflammatory drugs;
  2. sanitary-hygienic regime and medical nutrition;
  3. hormonal drugs;
  4. tuberculin;
  5. collapse therapy and surgical intervention.

Reactivity and resistance of organism, functions of nervous and hormonal systems, and restoration of physiological condition of organism could be normalized under influence of common hygienic-dietary measures, strict regimen with maximal use of natural resources.

Chemotherapy is the method of etiotropic treatment of tuberculosis with the help of the chemical agents. Cemotherapy is directed on one agent – mycobacterium tuberculosis with the purpose of suppression of MBT reproduction (bacteriostatic effect) or elimination of MBT in a host (bactericidal effect). The major factor for a choice of chemotherapy regimen is the resistance of MBT to anti tubercular drugs. On the basis of wide experience of tuberculosis chemotherapy the following principles are worked out, which are necessary to take into account at realization of chemotherapy of tuberculosis.

  1. Type of the MBT specific sensitivity which determines MIC (Minimal Inhibitory Concentration) of the drug in tissues. MIC is considered as a conditional constant.
  2. MBT drug resistance which constantly varies and requires the control with bacterial inoculation on specific media.
  3. Tolerance of the patient to a drug, vulnerability of host’s organs and systems.
  4. Ways and methods of drugs administration, doze of acting substance and speed of release from its medicinal form.
  5. Degree of penetration into the damaged tissue and physiological liquid.
  6. Ways and speed of excretion, features of metabolism and inactivation of antibacterial drug.
  7. Degree of patient’s compliance with the medical personal.

The matter of tuberculosis treatment is determined by the standards, which represent the schemes (standards) of treatment of the certain groups of patients with the account of the forms and phases of tubercular process. Within the schemes individual medical tactics are applied according to dynamics of disease course, MBT drug resistance, pharmacokinetics of used drugs and their interaction, host drug tolerance, presence of concomitant diseases. Such principle allows combining the standard tuberculosis treatment and personal tactics of treatment.

The turning-points.
The treatment, depending on a condition of the patient can be:

  1. outpatient;
  2. in the apartment, under supervision of the local doctor (dispensary);
  3. In hospital;
  4. In sanatorium or in health resort.

The treatment refers to as step-wise therapy, as the doctor changes conditions of treatment in the different periods of illness.

The regimen of labor, rest and adequate physical loading is the basic background of treatment at all phases of tuberculosis. Under the term regime is appreciated such day time regimen of the patient, which provides comfort condition for an organism. For that it is needed for the patient lengthened sleep hours with inclusion of two-hour rest in the afternoon, long stay on air, walking, sleeping in open air in summer and winter time, and in sever cases — treatment by oxygen in oxygen tents.

The hospitalization quite often is hardly withstood by the patient; therefore it is not so necessary completely to forbid this or that kind of work. Adequate, limited in time physical load, educational and scientific work, are recommended to the patients who are receiving treatment in medical establishments. In well organized tubercular establishments the patients can work in hospital workshops, work in garden, kitchen garden, and participate in gardening of a hospital territory. Such physical activity stimulates normalization of emotional state of the patients. For children, teenagers and high schools students the individual work according to the programs of those educational institutions are organized, where the patient has interrupted study because of illness.

The rational diet is obligatory component of tuberculosis modern therapy. It plays a role of pharmacodynamic agent for normalization of the damaged physiological functions of a body. Therefore the diet should be strictly individual for each patient. The food should content the fibers, fats and carbohydrates in optimum quantity and in the certain proportion. In tuberculosis it is recommended the increased quantity of proteins, mostly of animal variety, and moderate amount of carbohydrates. The ratio between these ingredients should be the following: 15 — 20 % of proteins, 25 — 35 % of fats, and the rest — carbohydrates. Tuberculosis patients with weight deficiency should be provided with a diet exceeding norm by 15-20%. The big importance for the tuberculosis patients is to take multi-vitamins. The multi-vitamins are prescribed as drinks, fruits and drugs (intra muscular or per os). The quality, variety and taste of food are very important. Various and tasty food should be served 4-5 times a day.

Sanatorium and resort treatment of the tuberculosis patient in the Russian Federation became the organized form of application of modern methods of complex therapy and most important stage in treatment of the patients, especially with the in time revealed fresh tubercular processes. The purpose of sanatorium treatment of such patients is complete clinical healing. In the patients with an aggravated chronic process the sanatorium treatment allows to achieve liquidation of an aggravation of disease and prevention of repeated aggravations.

To direct the patients to climatic resorts following elimination of sharp inflammation of process. Taking into account, that tuberculosis is social disease, its treatment should be maximally standardized and correspond to regulations and instructions of public health services, independent of whether there is in the given country specialized phthisiatric service or not.

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