Treatment of tuberculosis: how to treat, what drugs are effective? ATB and other principles

The primary goal of tuberculosis treatment is, of course, to cure the infected patient and to prevent death. An important aspect of treatment is also the prevention of late sequelae, the prevention of relapse and the prevention of transmission of tuberculosis to others who have come or will come into contact with the patient.

Treatment may be indicated and prescribed by a physician specialised in pneumology and phthisiology.

The physician is professionally responsible for the correct indication of treatment and dosage adjustment. He is also responsible for monitoring and early detection of adverse effects of treatment.

Antituberculosis drugs are used in the treatment of tuberculosis. These chemotherapeutic drugs have three characteristics:

• bactericidal - killing the bacteria
• can sterilise the environment
• protect against the emergence of mycobacterial resistance

In modern medicine, bactericidal antituberculosis drugs are used in short courses. Isoniazid and rifampicin are the most potent bactericidal antituberculosis drugs that are effective against all strains of TB.

• Isoniazid (I) is the most aggressive drug. It is able to eradicate up to 90% of mycobacteria in as little as one week.
• Rifampicin (R) is effective against rapidly multiplying bacteria and destroys so-called persister bacteria, which are bacteria that remain inactive for a long time and could become active at any time.
• Pyrazinamide (P) is able to act in acidic environments. It effectively destroys bacteria that have engulfed macrophages.
• Streptomycin (S) acts against mycobacteria that live outside the cell, i.e. in the extracellular environment.
• Ethambutol (E) is effective in combination with the previous drugs. Its importance lies in the prevention of drug resistance.

The combination of these drugs is the key to avoiding the emergence of mycobacterial resistance to antituberculosis drugs.

The basic combination is isoniazid, rifampicin and pyrazinamide.

In a person with first-time confirmed tuberculosis, a 6-month treatment regimen is sufficient. A four-drug combination is given for two months, followed by a 4-month continuation phase in a two-drug combination.

For relapsing disease, up to five-combination in the initial phase and three-combination in the continuation phase are used.

In case of extensive chest X-ray findings, persistent microscopic positivity and poor clinical condition of the patient, the initial phase in quadruple combination is extended from two to three months. The continuation phase is the same for 4 months.

The total duration of treatment is thus extended to 7 months.