Lecture topic:
«TREATMENT OF TUBERCULOSIS PATIENTS: GENERAL PRINCIPLES, CHEMOTHERAPY, COLLAPSE THERAPY, SURGICAL METHODS OF TREATMENT, AND PATHOGENETIC THERAPY.»
Lecturer: M.D. Babayeva I. Y.
The goal of treatment of patients with tuberculosis is elimination of clinical signs of tuberculosis and stable healing of tubercular changes with restoration of patients' ability to work and social status.
Basic methods of treatment of tuberculosis: 1.Antituberculosis chemotherapy.
2.Homeostasis correction (regimen, diet, symptomatic treatment).
3.Collapse therapy.
4.Surgical treatment.
CRITERIA FOR THE EFFECTIVENESS OF TREATMENT OF TUBERCULOSIS PATIENTS:
1.Disappearance of clinical and laboratory signs of tuberculous inflammation.
2.Stable cessation of bacteriological excretion confirmed by microscopic and bacteriological studies.
3.Regression of radiological manifestations of tuberculosis (focal, infiltrative, destructive).
4.Restoration of functional capabilities and ability to work.
THE MAIN COMPONENTS OF TREATMENT OF
TUBERCULOSIS PATIENTS:
1.Chemotherapy (etiotropic anti- tuberculosis therapy).
2.Surgical treatment.
3.Pathogenetic treatment.
4.Collapse therapy.
CHEMIOTHERAPY – etiotropic (specific) treatment of patients aimed at destroying the mycobacterial population (bactericidal effect) or suppressing its reproduction (bacteriostatic effect).
The efficacy of chemotherapy has always been evaluated from a clinical point of view.
PRINCIPLES OF CHEMOTHERAPY:
1.The use of evidence-based and approved in Russia anti-tuberculosis drugs (ATDs).
2.Complexity (at least 4 PTPs at a time).
3.Continuity.
4.Adequate length of therapy.
5.Chemotherapy Control.
FACTORS INFLUENCING THE CLINICAL
EFFECTIVENESS OF PTP:
1.Numbers of mycobacterial population.
2.Sensitivity of mycobacterial population to the drugs used.
3.Drug Concentration.
4.Degree of penetration of the drug substance into the affected areas and activity in them.
5.Ability of drugs to act on extra- and intracellular (phagocytosed) mycobacteria of tuberculosis
4 POPULATION OF MYCOBACTERIUM TUBERCULOSIS IN THE FOCUS OF ACTIVE SPECIFIC INFLAMMATION:
1.By localization (extracellularly located and intracellularly located).
2.On drug resistance.
3.According to metabolic activity (higher in extracellularly located, lower in intracellularly located, minimal in persistent forms).
TWO PHASES OF CHEMOTHERAPY:
1.The initial, or INTENSIVE, phase of treatment is aimed at suppressing the rapid reproduction and active metabolism of the mycobacterial population.
The goals of this treatment period are also to reduce the number of drug-resistant mutants and to prevent the development of secondary drug resistance.
For treatment of tuberculosis in the intensive phase, five main PTP are used: isoniazid (bactericidal effect), rifampicin (bactericidal effect), pyrazinamide, ethambutol or streptomycin for 2 to 3 months.
2.The CONTINUING PHASE of treatment is aimed at the remaining, slowly multiplying mycobacterial population. The pathogen is mainly intracellular in the form of persistent forms. At this stage the main objectives are prevention of active reproduction of the remaining bacteria, as well as stimulation of reparative processes in the lungs.