There are many ways to manage tuberculosis include drug regimens and also vaccine development. The purposes of managing tuberculosis are that we can prevent the exacerbations of the disease and also we can totally remove the pathogens that present in our body.
The management of tuberculosis will also prevent the transmission of the disease to other people and to prevent the recurrent infection of the patient in the future. Tuberculosis is a well-known disease in which it will affect the population in the world. The treatment for this disease in term of drug already exists for more than 50 years old. Yet, why the prevalence of the tuberculosis is not getting less instead it increases in a high rate? This is because the management of the disease is not proper although there are many drug regimens to treat the disease. In order to has a proper anti-tuberculosis drug treatment, short-course chemotherapy (SCC) has to be applied to the patients. In order to make sure that SCC is being carried out in a proper manner, well managed TB control programme (NTP) has to be done.
In the standardized TB treatment, there are many treatment regimens available to treat tuberculosis. Each country will apply different standard regimens to fulfil the purposes of anti-TB drug treatment. The regimen for tuberculosis is the most cost- effective of all the interventions and it is affordable for all walks of life. There are certain drugs which are classified into first-line anti- TB drugs and they have different modes of action, potency and dose applied. The drugs include isoniazid (H), rifampicin (R), pyrazinamide (Z), thioacetazone (T), streptomycin (S), and also ethambutol (E). These drugs are divided into two main types which are bactericidal and bacteriostatic. Bactericidal drugs will kill the bacteria while bacteriostatic will only slow down the production and growth of the bacteria.
Among these drugs, all of them can be used in the intermittent use except thioacetazone. Intermittent use of drugs mean that the drugs are consumed for a time and stop for a time, then continues back. Thioacetazone cannot be used for intermittent purpose and it has many side effects as it will cause toxicity to the people who consume it and it will also cause severe skin reactions. Besides, it also has low property of bacteriocidal action.
Thus, it is now seldom be used. It is now been substituted with other drug like ethambutol. The above drugs that mention above act on different groups of bacilli. Tuberculosis bacilli in a tuberculosis patient are divided into different groups such as bacilli that are metabolically active, continuously growing in the host body.
There are also bacilli that stay inside cells such as macrophages. Moreover, there is semidormant bacilli which will undergo occasional spurts of metabolic activity and also dormant bacilli. Dormant bacilli will fade away and die away. Among these bacilli, semidormant bacilli is the most difficult bacilli to remove. That’s why the anti- tuberculosis treatment needs longer period to act against different groups of bacilli. Isoniazid, rifampicin, pyrazinamide and streptomycin are the drugs that classified as bactericidal drugs. Among these drugs, isoniazid is the best to kill the metabolically active bacilli.
It almost can kill 90% of continuously growing bacilli. Nevertheless, isoniazid cannot kill semidormant bacilli but rifampicin can. The bacilli that live inside the cells like macrophages are killed by pyrazinamide. This bacilli are killed in the acid condition inside the cells. The table below shows how the drugs are being consumed in order to help to eliminate the bacilli present in the body. First line anti-TB drugs Recommended dose (mg/kg of body weight) Intermittent (3 times a week) DailyIsoniazid(H) 10 5Rifampicin(R) 10 10Pyrazinamide(Z) 35 25Streptomycin(S) 15 15Ethambutol(E) 30 15Thioacetazone(T) Not applicable 2.5Like what had mentioned above, semidormant bacteria is the toughest bacilli to be removed through our body.
Thus, rifampicin which is able to remove this bacteria is considered to be the most effective drugs to treat tuberculosis drugs. There are some of the bacilli that are considered to be drug-sensitive bacilli in which they are resistant to certain drugs and they are very difficult to be removed. This is why sometimes we need the combination of the drugs in order to provide a wide range of bactericidal and bacteriostatic action. Isoniazid and rifampicin are the best combination in order to prevent the bacilli which will easily develop the resistance property to some drugs. Stremptomycin and ethambutol are less effective if compared to combination of isoniazid and rifampicin.