What is it about ?
Anti-tuberculosis drugs are drugs used to treat tuberculosis. Tuberculosis is a serious and contagious disease caused by bacteria. Infection occurs by inhaling contaminated droplets projected into the air by a person with tuberculosis when they cough.
What is its frequency?
In 2017, there were 8.6 new cases of tuberculosis per 100,000 inhabitants in Belgium. In Flanders, 386 cases of tuberculosis were reported that year.
The groups at risk are the disadvantaged people, the homeless, detainees, asylum seekers, new arrivals from countries where the disease is frequent… Poor housing, hygiene and food conditions also play a role. a role.
About a third of the world’s population is infected with the bacterium that causes tuberculosis, but without showing symptoms or an active form of the disease. This is called latent tuberculosis infection (LTBI). The chance that a person with latent TB infection will develop active TB is about 10%. In half of the cases, this development occurs within two years after contamination.
How to recognize it?
Tuberculosis is a slow growing infection. The time between contamination and the appearance of the first symptoms is quite long. Symptoms in active tuberculosis are often not very specific. Fatigue, listlessness, fever, and night sweats may appear. If the lungs are infected, there may be a persistent cough producing thick, yellow mucus (pus).
In advanced stages, the patient loses weight and becomes weak. Other parts of the body can also be affected, such as the vertebrae, joints, lymph nodes, gastrointestinal tract and blood.
What can the doctor do?
If there is a high risk of infection for those around the patient, the patient is often isolated, and treatment is started in the hospital. Once the contagion period has passed, treatment can continue at home (on an outpatient basis).
The classic treatment consists of combining drugs in a gradually decreasing pattern: first four different drugs (rifampicin, isoniazid, ethambutol and pyrazinamide) are taken together for two months, then only two (rifampicin and isoniazid) for four months. Taking the medicine regularly (at the same time every morning) is essential for the success of the treatment.
However, drugs can cause several side effects. Some patients then tend to stop taking the medicine or reduce the dose. That is why it is also important that patients see the doctor regularly so that he can immediately adjust the treatment if there is a problem.
The sensitivity of bacteria to the drug is tested beforehand. During treatment, sputum (mucus) is regularly cultured to detect the presence of germs. In addition, regular blood tests are used to detect possible side effects early. This allows the doctor to see if the patient is responding well to the medication. In pulmonary tuberculosis, x-rays of the lungs are also carried out regularly.
It is very important to take the medicines correctly in order to prevent resistance of the bacteria. People who come from an area at increased risk for resistance, who have already been treated or are not sure that treatment has gone well, start with a combination of five drugs. The drug regimen is then adapted according to the results of the culture in the laboratory.
Main side effects of drugs
- Rifampicin: red coloration of all excretions (urine, tears …), liver disorders, gastrointestinal symptoms, rash, blood disorders, shock, difficulty in breathing ;
- Isoniazid: liver problems, rash, fever, convulsions, nerve damage, psychic symptoms;
- Ethambutol: inflammation of the optic nerve (possibly with reduced visual acuity and color vision), rash;
- Pyrazinamide: liver disorders, joint pain, increase in sensitivity to sunlight, nausea, hot flashes.
What about latent tuberculosis infection?
Latent tuberculosis infection (LTBI) should not normally be treated unless the doctor considers that the risk of it getting worse, for example when starting treatment which suppresses the immune system (prescribed for another disease).
In the case of people at risk who have been in contact with a person with tuberculosis active, initiation of therapy should be carefully considered.
Want to know more?
FARES – Respiratory Affections Fund
Sources