Drug-resistant tuberculosis

Multiply drug-resistant TB
Re-emergent tuberculosis

Management of tuberculosis refers to techniques and procedures utilized for treating tuberculosis (TB), or simply a treatment plan for TB.

The medical standard for active TB is a short course treatment involving a combination of isoniazid, rifampicin (also known as Rifampin), pyrazinamide, and ethambutol for the first two months. During this initial period, Isoniazid is taken alongside pyridoxal phosphate to obviate peripheral neuropathy. Isoniazid is then taken concurrently with rifampicin for the remaining four months of treatment (6-8 months for Miliary tuberculosis). A patient is expected to be free from all living TB bacteria after six months of therapy in Pulmonary TB or 8-10 months in Miliary TB.

Latent tuberculosis or latent tuberculosis infection (LTBI) is treated with three to nine months of isoniazid alone. This long-term treatment often risks the development of hepatotoxicity. A combination of isoniazid plus rifampicin for a period of three to four months is shown to be an equally effective method for treating LTBI, while mitigating risks to hepatotoxicity. Treatment of LTBI is essential in preventing the spread of active TB.

Source: Wikipedia

Hospital staff in developed countries do not expect tubercular patients. In Italy, the sanatoria for TB victims was dismantled in the 1970's. Hospital staff may fail to isolate tubercular patients or decontaminate equipment properly to prevent the spread of the disease. In addition, their tuberculosis is now often virtually untreatable, being deadlier than both the Ebola virus and the bubonic plague.

Doctors may fail to prescribe the full range of drugs required and the patient stops taking drugs when he feels better, even though he may not be cured. These two practices enhance drug resistance.

It will cost governments and the drug industry $500 million a year to prevent a resurgence of tuberculosis. One therapy that works is DOTS, or directly observed treatment short-course, which involves monitoring the patient's drug-taking over the entire lengthy course of treatment.

Treating normal tuberculosis costs about $11 per patient, but medicines for drug-resistant TB can cost up to $250,000 per patient and still fail to cure him. Obviously, it is critical to cure TB before it becomes drug-resistant.

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(G) Very specific problems