Because there is more than one form of tuberculosis, there is no single treatment. Doctors have had to devise different ways of fighting the disease. Fortunately, these methods work very well. Most of the people who get tuberculosis can be cured. Doctors sort patients with tuberculosis into two general groups: those who have latent tuberculosis and those who have active tuberculosis. Each group is treated with different medications.
If tests show that a person is infected with Mtuberculosis but has no symptoms of tuberculosis, he or she may be one of the lucky 90 percent of the people infected with tuberculosis who get the latent form. He or she can live a long and healthy life, never suffer from the disease, and never pass it on to anyone.
Someone with latent tuberculosis who has a healthy immune system does not have to worry about it. As a precaution, however, a doctor may prescribe the drug isoniazid. INH is an antibiotic discovered in 1952. Doctors usually give it to patients with latent tuberculosis. They take the medicine every day for at least six months. Except for checkups, patients with latent tuberculosis never have to do anything special after that.
Treatment is more complicated for people with active (infectious) tuberculosis. Active tuberculosis is potentially dangerous not only for the patients themselves, but also for people around them. Experts estimate that one person with active tuberculosis who is not treated can spread the disease to as many as fifteen people in a year.
Treating an infectious person is a bit tricky. Different types of tuberculosis bacteria can infect people, and no single antibiotic can kill them all. For most people, a four-drug combination works best. Patients take the antibiotics isoniazid, rifampin, ethambutol, and pyrazinamide. The entire treatment period lasts six months. For the first two months, patients take all four drugs every day. For the last four months, they take only two of the drugs - isoniazid and rifampin - every day. Usually people recover if they follow doctors' orders.
However, not everyone does recover. As people with infectious tuberculosis quickly learn, they have to take a lot of pills - up to six per day. Another problem occurs when a tuberculosis patient starts feeling better - usually after only about two weeks. Some tuberculosis patients start to think they are cured, so they stop taking the drugs before the six-month deadline.
Still others may stop taking the drugs because they do not like the side effects - feeling tired or sick to their stomachs. There are two problems with stopping treatment too soon.First, a patient might get sick again. Second, the remaining bacteria may become drug resistant - harder to kill with standard drugs. This is when the disease turns into MDR-tuberculosis.
Patients with MDR-tuberculosis can still be cured, but the two most powerful tuberculosis medications - isonaizid and rifampin - are useless. Doctors have to use newer drugs, which are more expensive than older ones. Treatment of MDR-tuberculosis can last as long as two years. In addition, even this second group of drugs will not help a small number of patients. They turn out to have what is called extensively drug-resistant tuberculosis (XDR-tuberculosis). This is even more difficult to treat than MDR-tuberculosis. These patients need very special, very expensive drugs and may not be completely cured.
To make sure their patients take all their pills and do not develop the harder-to-cure types of tuberculosis, some hospitals and clinics have a program called directly observed therapy (DOT). In this program, a health care worker sits with a tuberculosis patient every day and watches him or her take the prescribed pills. This program is for high-risk patients, such as people with HIV, homeless people, prisoners, and people who have been careless about taking their drugs in the past. This simple method has been very effective in helping people get better.
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