Tablets for pulmonary tuberculosis in adults. The effectiveness of drugs against tuberculosis. How to take medications

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Application
Drugs used in the treatment of tuberculosis
Isoniazid(tubazide). Release form. Tablets 0.1; 0.2; 0.3 g; 10% solution for injection, 5 ml in ampoules.
Pharmacodynamics. Active against extra- and intracellular forms. Inhibits DNA-dependent RNA polymerase and stops the synthesis of mycolic acids in mycobacteria. Resistance of microorganisms with isolated use of isoniazid develops within 5 months.
Pharmacokinetics. Isoniazid is well absorbed from the gastrointestinal tract. Through
1-2 hours accumulates in the blood plasma in maximum concentrations, easily penetrates tissue barriers and is relatively evenly distributed throughout all tissues, found in bacteriostatic concentrations in the cerebrospinal fluid and serous cavities. Inactivated by acetylation. A larger amount of isoniazid and its metabolites is excreted during the first 24 hours, mainly by the kidneys.
Application. Used to treat all forms and localizations of active tuberculosis in adults and children. Most effective for fresh, acute processes. Adults are prescribed 0.3 g orally
2 - 3 times a day, the maximum single dose is 0.6 g, the daily dose is 0.9 g. For children, 5-15 mg/kg per day is prescribed orally, the frequency of use is 1 - 2 times a day. The maximum daily dose is 500 mg. Adults and adolescents are administered intramuscularly at 5-12 mg/kg per day, the frequency of use is 1-2 times a day. 5-10 mg/kg per day is administered intravenously once. After the injection, you must remain in bed for 1-1.5 hours.
Side effects. Headache, dizziness, nausea, vomiting, pain in the heart, allergic reactions in the form of skin rash, euphoria, sleep disturbance. Rarely - psychosis, peripheral neuritis, drug-induced hepatitis. Extremely rare - gynecomastia, menorrhagia. The neurotoxicity of isoniazid is associated with inhibition of the formation of pyridoxal phosphate, which is a coenzyme necessary for the transformation of amino acids.
To reduce side effects, according to the standards of the Ministry of Health of the Russian Federation (1998), all patients receiving isoniazid are prescribed pyridoxine 60-100 mg/day, as well as glutamic acid or thiamine.
Overdose and poisoning of GINK are accompanied by nausea, vomiting, blurred vision and slurred speech, later respiratory depression, stupor, coma, and difficult-to-control convulsions are possible. If the assistance provided is insufficient, death is possible.
First of all, in case of GINK poisoning, breathing control is necessary, and, if indicated, artificial pulmonary ventilation (ALV). Convulsions are stopped by administering short-acting barbiturates or pyridoxine at the rate of 1 mg of vitamin per 1 mg of isoniazid. An urgent blood test for sugar, electrolytes, acid-base status, and determination of glomerular filtration of the kidneys is necessary to resolve the issue of the need for hemodialysis. In case of poisoning with tablets, gastric lavage (effective within several hours after poisoning) and enterosorbents are indicated. If metabolic acidosis is detected, sodium bicarbonate is administered intravenously - once or repeatedly (guided by blood pH and sodium concentration).
Contraindications. Hypersensitivity to the drug; epilepsy, tendency to convulsive states; history of poliomyelitis; impaired renal and (or) liver function; phlebitis; pronounced atherosclerosis.
GINK in doses exceeding 10 mg/kg is contraindicated in pregnancy, coronary artery disease, stage 2-3 hypertension, bronchial asthma, psoriasis, acute eczema, chronic renal failure, acute hepatitis and cirrhosis of the liver.
Special instructions. The drug is prescribed with caution for severe forms of pulmonary heart failure, arterial hypertension, ischemic heart disease, widespread atherosclerosis, diseases nervous system, bronchial asthma, psoriasis, eczema in the acute phase, myxedema.
Rational combination. Prescribed in combination with other anti-tuberculosis drugs (streptomycin, ethambutol, rifampicin) and with other antibiotics, sulfonamides, vitamins A and B.

Homologues of GINK

Ftivazid. Release form. Powder and tablets 0.1; 0.3; 0.5 g.
Pharmacodynamics. Blocks the synthesis of mycolic acid, which ensures the acid resistance of Mycobacterium tuberculosis; disrupts the synthesis of phospholipids, forms intra- and extracellular chelate complexes with divalent ions, inhibits oxidative processes, DNA and RNA synthesis.
Pharmacokinetics. The drug is slowly and insufficiently absorbed from the gastrointestinal tract. Compared to isoniazid, the concentration of ftivazid in the blood increases more slowly, does not reach a high level, but remains within the effective therapeutic concentration for a longer time, the maximum concentration in the blood is reached after 1-2 hours. It is biotransformed in the liver. The drug penetrates the placental barrier and is excreted in breast milk. 95% of metabolites are excreted by the kidneys, a small amount by the intestines.
Application. Treatment of all forms and localizations of active tuberculosis in adults and children. Maximum effectiveness - with fresh, acute processes, infiltrates, pneumonic foci, perifocal inflammation, hematogenous dissemination.
Adults are prescribed 0.5 g 2-3 times a day. Higher doses for adults: single - 1 g, daily - 2 g. Children are prescribed at the rate of 0.02 - 0.04 g/kg per day (maximum daily dose - 1.5 g) in 3 doses. For tuberculous lupus, 0.25 - 0.3 g is prescribed 3 - 4 times a day, for a course - 40 - 60 g. The effect of ftivazid on chronic forms of tuberculosis is small.
Side effects. Headache, dizziness, nausea, vomiting, dry mouth, epigastric pain, increased bleeding, cardialgia, euphoria, sleep disturbance, allergic reactions. Rarely - mental reactions, optic neuritis, memory impairment, drug-induced hepatitis. In men - gynecomastia, in women - menorrhagia.
Contraindications. Angina; decompensated heart defects; organic diseases of the central nervous system; alcoholism; liver dysfunction; hypersensitivity to ftivazid; pregnancy, lactation (breastfeeding is stopped during treatment).
Special instructions. The drug can be used to treat patients with hypersensitivity to isoniazid. During the treatment period, observation by an ophthalmologist and periodic examination of the fundus are necessary.
Rational combination. Prescribed in combination with other anti-tuberculosis drugs, antibiotics, sulfonamides. To eliminate and prevent side effects, the use of pyridoxine and thiamine is recommended.
Undesirable combination. Strengthens side effects paracetamol, alcohol, benzodiazepines, carbamazepine, hepatotoxic drugs, anticoagulants, antiplatelet agents. Reduces the side effects of mineral and glucocorticoids. The absorption of ftivazid is slowed down by antacids.

Saluzide soluble. Release form. Ampoules of 5% solution of 1, 2 and 10 ml.
Application. Used in the form of subcutaneous, intramuscular, and intravenous injections for chemotherapy of tuberculosis of various localizations. Prescribed for injection into caseous lymph nodes, for washing fistulous tracts, introduction into the genitourinary tract, cervix and vaginal vaults, for tuberculous purulent serositis (for washing cavities), for tuberculosis of the upper respiratory tract, tuberculous eye damage.
10 ml of a 5% solution (0.05 g per injection) is injected subcutaneously and intramuscularly, daily dose up to 2 g; administer slowly (1 ml per 1 min) up to 10 ml of solution into a vein. It is most indicated for bronchial tuberculosis: 3 - 4 ml of a 5% solution is administered in the form of an aerosol intratracheally and intrabronchially - 2 - 3 ml of solution. For tuberculous meningitis, it can be administered into the spinal canal (in the form of a solution) at a dose of 1.5 - 5 mg/kg; for persons weighing 60 kg, 90-120 mg are prescribed.
Rational combination. It is recommended to combine with other anti-tuberculosis drugs. It is advisable to use it if you are intolerant to isoniazid.

Metazide. Release form. Powder, tablets 0.1; 0.3; 0.5 g.
Pharmacodynamics. Suppresses the growth and development of Mycobacterium tuberculosis, especially dividing ones. Disturbs the synthesis of membrane phospholipids and nucleic acids; stops the proliferation of mycobacteria located inside and outside the cells of the macroorganism.
Pharmacokinetics. Quickly and completely absorbed from the gastrointestinal tract; penetrates into the cerebrospinal fluid through the placenta. Tuberculostatic concentration in the blood remains for 24 hours.
Application. Treatment of all forms and localizations of tuberculosis in adults and children. Most effective for fresh, acute processes. The drug is prescribed orally. Dose for adults - 0.5 g 2 times a day; highest doses for adults orally: single - 1 g, daily - 2 g. Children are prescribed at the rate of 0.02 - 0.03 g/kg per day (no more than 1 g per day); The daily dose is prescribed in 2-3 doses.
Side effects. Headache, dizziness, sleep disorders, neuritis, convulsions, mental disorders (euphoria, temporary memory loss), dry mouth, nausea, vomiting, epigastric pain, pain in the heart, drug-induced hepatitis, skin rash.
Contraindications. Angina; decompensated heart defects; organic diseases of the central nervous system, visual impairment, epilepsy, history of seizures, pregnancy, lactation; liver and kidney diseases of a non-tuberculous nature, accompanied by impaired excretory function; hypersensitivity to the drug.
Rational combination: prescribed in combination with other anti-tuberculosis drugs, with broad-spectrum antibiotics.

Rifampicin. Release form. Capsules 0.15 g; 0.15 g in ampoules for injection.
Pharmacokinetics. Rifampin is quickly and completely absorbed from the gastrointestinal tract. After oral administration, its maximum concentration in the blood is determined after 2 - 2.5 hours. It easily penetrates tissue barriers, including the blood-brain barrier. The highest concentrations of the drug are formed in the liver and kidneys. When administered intravenously, the therapeutic effect lasts up to 8-12 hours. The drug is excreted in the bile, partly in the urine, bronchial and lacrimal glands.
Application. Used to treat all forms of tuberculosis of various localizations. It is more active than streptomycin and is active against mycobacteria resistant to isoniazid, streptomycin, and PAS. It is advisable to use rifampicin in patients with chronic disease when other anti-tuberculosis drugs are not effective. It is also used for infectious and inflammatory diseases caused by microorganisms sensitive to the drug (primarily resistant staphylococci), including osteomyelitis, bronchitis, pneumonia, pyelonephritis, otitis, cholecystitis, leprosy, meningococcal carriage, gonorrhea.
Dosage regimen. Take orally on an empty stomach 0.5-1 hour before meals or parenterally. Rifampicin is prescribed orally for adults at 0.3 - 0.6 g per day in 1 dose (depending on the indications). Maximum daily
dose - 1.2 g. For pulmonary tuberculosis, 0.45 - 0.6 g per day (in one dose) is prescribed before breakfast. The average daily dose for adults when administered intravenously is 0.45 g once a day. Children over 3 years of age are prescribed a dose of 10 mg/kg body weight per day 1-3 times, but not more than 0.45 g per day. For tuberculosis, the duration of treatment with the drug can be a year or more.
Side effects. Possible nausea, vomiting, diarrhea (dysbiosis), loss of appetite, negative effect on liver function (increased levels of liver transaminases, bilirubin in the blood serum). May occur headache, arthralgia, impaired coordination of movement, visual impairment, menstrual cycle, leukopenia, eosinophilia, urticaria, Quincke's edema, bronchospasm, flu-like symptoms, herpes. Rarely: acute renal failure, hemolytic anemia, thrombocytopenic purpura (with irregular therapy or resumption of treatment after a break). Very rare: renal tubular necrosis, interstitial nephritis.
Contraindications. Jaundice; severe dysfunction of the liver and kidneys; pregnancy, breastfeeding; hypersensitivity to rifampicin.
Special instructions. Colors urine, sputum and tear fluid red. Caution is required when used in premature and newborn children, and in malnourished patients.
Rational combination. Used in combination with other anti-tuberculosis drugs.
Undesirable combination. When combined with indirect anticoagulants (neodicoumarin, phenyline, syncumar, etc.), with oral hypoglycemic agents, digitalis preparations, rifampicin reduces their activity. It is not advisable to combine with sleeping pills, antipyretics, or cortisol.

Rifabutin(Mycobutin). Release form. Capsules 0.15 g.
Pharmacodynamics. Rifabutin has an antimicrobial effect on rifampicin-resistant MBT strains. The higher effectiveness of mycobutin compared to rifampicin is due to higher (3-4 times) intracellular penetration of the drug and the effect on DNA biosynthesis of rifampicin-resistant MBT at a concentration 8 times lower. The concentration of rifabutin in lung tissue 24 hours after administration is 5 to 10 times higher than in blood plasma. The half-life of rifabutin is 35-40 hours, which makes it possible to classify it as a long-acting drug. Rifabutin does not suppress the immune system and can be used in patients with immunodeficiency. Prescribing rifabutin with isoniazid, pyrazinamide, prothionamide is advisable, since there is a strong synergy between them.
In patients with liver diseases, hepatoprotectors are prescribed simultaneously with taking rifabutin: Riboxin 0.3 g 3 times a day and nootropil 480 mg 3 times a day before meals.
Pharmacokinetics. Absorbed quickly and completely from the gastrointestinal tract. The maximum concentration in the blood is reached after 2-4 hours. The BBB does not
passes, but penetrates well into the cells of various organs and tissues, creating a particularly high concentration in the lungs. Biotransforms in the liver, forming inactive metabolites. Excreted in the form of metabolites by the kidneys (53%), with bile (30%).
Application. For the treatment of pulmonary tuberculosis in adults - 0.15 -0.3 g orally. The course of treatment is 6 months. and more. For secondary mycoinfection - 0.4 - 0.6 g per day with a course of therapy of up to 6 months. with mandatory combination with other drugs, since monotherapy quickly develops resistance. Prescribed for MAIC infection in patients with acquired immunodeficiency syndrome.
Side effects. Insomnia, headache, chest pain, symptoms of asthenia, myalgia, arthralgia, various manifestations of dyspepsia: nausea, vomiting, diarrhea, abdominal pain; changes in the blood: anemia, leukopenia, thrombocytopenia; allergic reactions, itching, urticaria, skin rashes, bronchospasm, as well as uveitis, red staining of urine and tear fluid.
Contraindications. Hypersensitivity, including to antibiotics from the ansamycin group (rifampicin, rifaxinin, rifamycin), impaired liver and kidney function, pregnancy, age under 18 years.
Special instructions. When treating with rifabutin, it is necessary to monitor liver function and peripheral blood patterns.
Rational combination. Prescribed in combination with other anti-tuberculosis drugs, as their effectiveness is enhanced.
Undesirable combination. With oral contraceptives, as it induces the activity of the monooxidase system, with other medicinal substances that are biotransformed with the participation of cytochrome P-450.
Ethambutol. Release form. Tablets 0.1; 0.2; 0.4; 0.6; 0.8 g; capsules 0.25 g.
Pharmacodynamics. The drug has a pronounced tuberculostatic effect and does not affect other pathogenic organisms. Suppresses the proliferation of Mycobacterium tuberculosis resistant to streptomycin, isoniazid, PAS, kanamycin, ethionamide. The mechanism of action is associated with rapid penetration into the cell, where mycobacterial RNA synthesis and lipid metabolism are inhibited; Magnesium and copper ions bind, the structure of ribosomes and protein synthesis are disrupted. With monotherapy, drug resistance quickly develops.
Pharmacokinetics. It is not completely absorbed from the gastrointestinal tract (75 - 80%), but enough to provide a bacteriostatic effect. 20 - 30% binds to blood proteins. The maximum concentration of the substance in the blood plasma accumulates after 2-4 hours, a decrease of 50% occurs after approximately 8 hours. Penetrates into organs, tissues, biological fluids, breast milk, with the exception of ascitic, pleural and cerebrospinal fluid. It does not penetrate through the intact BBB. Biotransforms in the liver to form inactive metabolites. During the first day, 65% is excreted by the kidneys, 20% by the intestines.
Application. Used in the treatment of various forms of tuberculosis. Prescribed orally 1 time per day at the rate of 0.015 - 0.025 g/kg daily or 0.05 g/kg 2 - 3 times a week. Patients who have not previously taken anti-tuberculosis drugs are given a dose of 0.015 g/kg (with a weight of 60 - 70 kg - 0.9-1 g), previously treated patients - 0.025 g/kg (with a weight of 60 - 70 kg - 1.5 - 1.75 g) with transition after 1.5 - 2 months. by 0.015 g/kg. Children - 0.025 g/kg once in the morning after breakfast, the highest daily dose for children is 1 g.
Side effects. Possible nausea, loss of appetite, vomiting, dizziness, depression. Hallucinations and disorientation in space. There are allergic reactions in the form of skin rash, color perception disorder (mainly green and red), a decrease in the central and peripheral fields of vision, and the occurrence of scatomas. Rarely: toxic retrobulbar optic neuritis, exacerbation of gout attacks, hyperuricemia, leukopenia. To reduce side effects, nicotinamide and vitamin B6 are prescribed.
Contraindications. Renal dysfunction; pregnancy; acute gastrointestinal diseases; optic neuritis; cataract; diabetic retinopathy; inflammatory eye diseases; breast-feeding; hypersensitivity to the drug.
Special instructions. Side effects are reversible and disappear a few weeks after stopping the course of treatment. At the beginning of treatment, the cough may increase and the amount of sputum may increase. Ethambutol is prescribed only after starting treatment with other anti-tuberculosis drugs and only in combination with them. With monotherapy, resistance to ethambutol quickly develops. Ethambutol reduces visual acuity, so caution should be exercised when prescribing it to patients potentially engaged in dangerous species activities requiring visual acuity and increased attention. When carrying out long-term therapy, it is necessary to monitor visual function, peripheral blood patterns, as well as the functional state of the liver and kidneys.
Rational combination. Used in combination with other anti-tuberculosis drugs.
Undesirable combination. Increases the neurotoxicity of aminoglycosides, asparaginase, carbamazepine, ciprofloxacin, imipenem, lithium salts, methotrexate, quinine.

Pyrazinamide. Release form. Tablets of 0.5 and 0.75 g.
Pharmacodynamics. It has a bacteriostatic and bactericidal effect on intracellular mycobacteria that are resistant to other anti-tuberculosis drugs of groups 1 and 2. The mechanism of action is unknown in detail.
Pharmacokinetics. It is well absorbed from the gastrointestinal tract, the maximum concentration in plasma is reached after 1-2 hours. It binds to blood plasma proteins by 10 - 20%. Penetrates into various tissues and biological fluids, through the blood-brain barrier, as well as into foci of tuberculous lesions; active in the environment of caseous masses. Metabolized in the liver to form active pyrazinoic acid, which is then oxidized into 5-hydroxypyrazinoic acid, which loses its mycostatic activity. About 70% of the administered dose of the drug is excreted within 24 hours in the urine, mainly in the form of metabolites (3% unchanged, 33% in the form of pyrazinoic acid and 36% in the form of other metabolites).
Application. Often prescribed for caseous lymphadenitis, tuberculomas and caseous-pneumonic processes. Daily dose for adults - 1.5 -2 g; taken orally after meals, 1 g 2 times a day (less often - 0.5 g 3 - 4 times a day). The daily dose for patients over 60 years of age and weighing up to 50 kg is 1.5 g. The highest daily dose is 3 g. Children are prescribed at the rate of 0.015 - 0.02 g/kg per day (the daily dose is no more than 1.5 g ). The course of treatment is from 6 months. up to 2 years.
Side effects. Possible nausea, vomiting, diarrhea, anorexia, arthralgia, myalgia, hyperuricemia, allergic reactions in the form of skin rash, itching, angioedema. Increases the tendency to thrombosis. Rarely: exacerbation of gout, photosensitivity. Hepatotoxic, causes agranulocytosis.
Contraindications. Severe liver dysfunction; gout; pregnancy; hypersensitivity to the drug.
Special instructions. With monotherapy, mycobacterial resistance to pyrazinamide quickly develops, and therefore it is usually used with other anti-tuberculosis drugs. With long-term use of the drug, it is necessary to regularly monitor liver function and the level of uric acid in the patient’s blood.
Rational combination. Effectively combined with other anti-tuberculosis drugs. To reduce the toxic effect of pyrazinamide, it is recommended to prescribe it simultaneously with methionine, lipocaine, glucose, and vitamins B6, B|2.
Undesirable combination. Reduces the effectiveness of anti-gout drugs.

Ethionamide. Release form. Film-coated tablets, 0.25 g; dragees 0.25 g; candles 0.5 g.
Pharmacodynamics. Suppresses the synthesis of mycobacterial peptides located extra- and intracellularly, acts on resistant (refractory) and atypical forms. More active in acidic environment. Enhances phagocytosis at the site of tuberculous inflammation, which promotes its resorption. When treating patients, a gradual decrease in the bacteriostatic activity of the drug is observed.
Pharmacokinetics. Absorbed slowly from the gastrointestinal tract. The maximum concentration in plasma is after 1-3 hours. It is quickly distributed throughout the tissues of the body. Penetrates well through the blood-brain barrier into the cerebrospinal fluid. Inactivated in the liver. Excreted in the urine in the form of metabolites.
Application. For various forms and localizations of the tuberculosis process (pulmonary and extrapulmonary tuberculosis), in case of intolerance or ineffectiveness of other anti-tuberculosis drugs, always as part of complex tuberculostatic chemotherapy. Less active than tubazide and streptomycin, but actively affects mycobacteria resistant to these drugs. Prescribed orally and in suppositories. Adults are prescribed 0.25 g orally 3 times a day, with good tolerance - 0.25 g 4 times a day. The initial daily dose is 0.25 g after 5 days, subject to good tolerance, it is increased to 0.5 g, after another 5 days - to 0.75 g.
In case of poor tolerance, patients over 60 years of age, with a body weight of less than 50 kg, are prescribed 0.25 g 2 times a day, the drug is taken after meals. The daily dose for children is 0.01-0.02 g/kg, but not more than 0.75 g per day.
Prescribed in suppositories for severe dyspeptic symptoms; the dose is increased by 2 times.
Side effects. Gastrointestinal discomfort (anorexia, stomatitis, nausea, epigastric pain, impaired liver function), hematopoietic disorders, gynecomastia, dysmenorrhea, allergic reactions, neurological and mental disorders, orthostatic hypotension, impotence, manifestations of hypovitaminosis B are observed.
Contraindications. Hypersensitivity; liver dysfunction; pregnancy.
Special instructions. Restrictions on use are required for diabetes and epilepsy.
Rational combination. With the main anti-tuberculosis drugs, if mycobacteria are still sensitive to them, as well as together with cycloserine (with caution), pyrazinamide. To eliminate side effects, nicotinamide is prescribed - 0.1 g 2 - 3 times a day, pyridoxine - 1 - 2 ml of a 5% solution intramuscularly.
Undesirable combination. When combined with cycloserine, the risk of developing neurotoxic effects in patients increases.

Prothionamide. Release form. Tablets 0.25 g.
Pharmacodynamics. Blocks the synthesis of mycolic acids, which are a component of the cell wall of Mycobacterium tuberculosis, disrupts the synthesis of mycobacterial protein; has nicotinic acid antagonist properties. Inhibits extra- and intracellularly located Mycobacterium tuberculosis, exhibits bacteriostatic effects mainly against multiplying forms, including atypical ones. With treatment, resistant strains quickly form.
Pharmacokinetics. Rapidly absorbed from the gastrointestinal tract; maximum concentration in the blood is 2-3 hours after ingestion; penetrates through the BBB, as well as into healthy and pathologically altered tissues (lung cavities, tuberculous lesions, serous and purulent pleural effusion, cerebrospinal fluid in meningitis). Metabolized, partially converted into sulfoxide, which has anti-tuberculosis activity. It is excreted mainly in urine and feces, both unchanged (15 - 20%) and in the form of metabolites.
Application. For various forms and localizations of the tuberculosis process, with poor tolerance to ethionamide and other anti-tuberculosis drugs. Protionamide is administered orally after meals. Adults are prescribed 0.25 g 3 times a day; if well tolerated - 0.5 g 2 times a day; in patients over 60 years of age and weighing less than 50 kg, the daily dose should not exceed 0.75 g. Children are prescribed at the rate of 10 - 20 mg/kg per day.
Side effects. Dyspeptic disorders, headache, dizziness, tachycardia, depression, weakness, paresthesia, skin reactions.
Contraindications. Pregnancy, childhood.
Special instructions. During treatment with prothionamide for liver diseases, it is necessary to regularly monitor its function. Resistant strains of mycobacteria are rapidly developing to the drug, so co-administration with anti-tuberculosis drugs that have a different mechanism of action is required.
Rational combination: with isoniazid, pyrazinamide, cycloserine and other anti-tuberculosis drugs.
Undesirable combination. Should not be prescribed if Mycobacterium tuberculosis develops resistance to ethionamide; enhances the toxic effects of ethyl alcohol.

Streptomycin group

Streptomycin. Release form. Powder for injection in bottles of 0.25; 0.5; 1 year
Pharmacodynamics. It has a wide spectrum of antibacterial activity, is bacteriostatic and bactericidal against most gram-positive and gram-negative microorganisms. Penetrating inside the microbial cell, it binds to specific receptor proteins, disrupting the formation of a complex between messenger RNA. As a result, polyribosomes disintegrate, defects occur when reading information from DNA, and defective proteins are synthesized, which leads to the cessation of cell growth and development. At higher concentrations, streptomycin damages the cytoplasmic membranes and the cell dies.
Pharmacokinetics. Streptomycin is poorly absorbed from the gastrointestinal tract and is used only parenterally. At intramuscular injection quickly and completely absorbed into the blood. Penetrates into the lungs, liver, extracellular fluid, placenta and breast milk. It does not pass through the intact blood-brain barrier and binds to blood proteins by less than 10%. It is not subject to metabolism. Excreted by the kidneys (95%) unchanged.
Application. Prescribed for the treatment of tuberculosis of various localizations, mainly in the first 2 months. combination chemotherapy, since the drug acts only on extracellular forms, and after 2 months. mycobacteria penetrate the cell, and the use of the drug becomes ineffective. The disadvantage is the rapid development of resistance of mycobacteria to streptomycin. Used for purulent-inflammatory processes of various localizations.
Streptomycin is administered intramuscularly and into the cavities. Injection solutions are prepared at the rate of: 1 g of the substance in 2 - 5 ml of sterile isotonic sodium chloride solution or 0.25 -0.5% novocaine solution. Adults are administered intramuscularly at 0.5-1 g per day (in 1-2 doses). Higher doses for adults: single - 1 g, daily - 2 g. For pulmonary tuberculosis, a daily dose of 1 g is usually administered in one dose; in the first 3 - 5 days of treatment, 0.5 g is prescribed 2 times a day; in case of poor tolerance, the daily dose is limited to 0.75 g. For children with tuberculosis, streptomycin is prescribed at the rate of 0.015 - 0.02 g / kg, but not more than 1 g per day. For elderly people, a dose of 1/3 less than the norm is used.
The drug is also used in the form of an aerosol (0.2 - 0.25 g in 35 ml of isotonic sodium chloride solution) daily or every other day, for a course of 15 - 20 inhalations. Prescribed intratracheally at 0.25 - 0.5 g in 5 - 10 ml of 0.25 -0.5% solution of novocaine 2 - 3 times or more per week, intracavernosally - insufflation in the form of fine powder and inhalation of 10% solution 1 time per day - no more than 1 g.
Side effects. Renal dysfunction, convulsions, deafness, vestibular nerve damage, nausea, vomiting, respiratory depression, polyneuropathy, allergic reactions, increased bleeding.
Contraindications. Hypersensitivity to the drug, damage to the auditory nerve, myasthenia gravis, impaired renal function, tendency to bleeding, pregnancy.
Special instructions. If allergic reactions occur, which are often observed during the first weeks of treatment, streptomycin injections should be discontinued immediately. Once the skin rash and fever have resolved, desensitization can be attempted.
If possible, streptomycin should not be prescribed to children, since its injections are painful and the drug can lead to irreversible changes in the auditory nerve. As a result of the accumulation of the drug in the body, signs of intoxication may appear in elderly patients and people suffering from kidney disease. It is necessary to periodically determine the concentration of the drug in the blood serum: the concentration determined before the next dose is administered should not exceed 4 mcg/ml.
The drug should not be prescribed during pregnancy, as it crosses the placenta and can cause pathological changes in the auditory nerve and kidneys in the fetus.
Rational combination. Combination with other anti-tuberculosis drugs is effective. To reduce side effects, use in combination with diphenhydramine, calcium chloride, vitamin B and calcium pantothenate - 2 ml of a 20% solution 2 times a day intramuscularly.
Undesirable combination. When co-administered with monomycin, kanamycin, neomycin, lobeline, cytiton, sodium thiosulfate, the oto- and nephrotoxicity of streptomycin increases. Parenteral administration of indomethacin slows down the excretion of streptomycin. The drug increases the side effects of muscle relaxants, methoxyflurane, and reduces the effectiveness of antimyasthenic drugs.

Pasomycin. Release form. Bottles containing 0.5 and 1 g (500,000 and 1,000,000 units).
Pharmacodynamics. It is a salt of dihydrostreptomycin and PAS. Combines the mechanism of action of aminoglycosides and sulfonamides.
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Application. Used to treat various forms of tuberculosis. For nonspecific pneumonia and purulent processes, it is administered intramuscularly. The dose for adults is 1 g per day once. Children under 1 year are prescribed 0.1 g, from 1 year to 3 years - 0.2 - 0.25 g; 3 - 7 years - 0.2 - 0.3 g; 7 - 12 years - 0.3 - 0.5 g per day. Pasomycin solution can be injected into the fistula tracts and into the pleural cavity (0.25 - 0.5 g).
Rational combination. Prescribed in combination with other anti-tuberculosis drugs and antibiotics.
Undesirable combination. It is not recommended to prescribe pasomycin simultaneously with kanamycin, florimycin, monomycin and other antibiotics that have oto- and nephrotoxicity.

Kanamycin. Release form. Kanamycin monosulfate tablets, 0.125 and 0.25 g; kanamycin sulfate powder for injection in bottles of 0.5 and 1 g.
Pharmacodynamics. It has a wide antibacterial spectrum and has bacteriostatic and bactericidal effects. The mechanism of antimicrobial action is associated with inhibition of protein synthesis in bacterial cells.
Pharmacokinetics. Slightly absorbed from the gastrointestinal tract. When administered intramuscularly, the maximum plasma concentration is determined after 1 hour. The antibacterial effect lasts up to 6 - 12 hours. Penetrates the pleural cavity, synovial fluid, bronchi, and bile. Passes through the placental barrier. It usually does not penetrate the BBB, but during inflammation of the meninges it is found in the cerebrospinal fluid and is excreted by the kidneys within 24-48 hours. When taken orally, it is excreted unchanged through the intestines.
Application. The basis for the use of kanamycin is the ineffectiveness of other antibiotics. Used intramuscularly, intravenously and inhalation in the form of an aerosol for tuberculosis of the larynx, bronchi and lungs. The duration of treatment is no more than 2 months.
Adults are prescribed 1 g per day (in 2 doses or as a single injection). The highest daily dose for adults is 2 g. Administered for 6 days with a break every 7th day for a course of 1 month. and more. Children are administered only intramuscularly at the rate of 0.015 - 0.02 g/kg per day (no more than 0.75 g per day). Kanamycin sulfate is dissolved at the rate of 0.5 g in 3 - 4 ml of 0.25 -0.5% solution of novocaine or isotonic sodium chloride solution and injected deep into the muscles. Sometimes a 0.25% solution is injected into the cavities, and the daily dose should not exceed the daily dose for intramuscular administration. For aerosol therapy, dissolve 0.25 - 0.5 - 1 g of the drug in 3 - 5 ml of isotonic sodium chloride solution or 0.25 -0.5% novocaine solution.
Side effects. Nausea, vomiting, diarrhea, intestinal obstruction, auditory neuritis, paresthesia, liver dysfunction, nephrotoxicity.
Contraindications. Hypersensitivity, inflammation of the auditory nerve, impaired liver and kidney function, intestinal obstruction.
Special instructions. Do not use during pregnancy or in children in the first month of life.
Rational combination. With other anti-tuberculosis drugs, with antibiotics (penicillin, nystatin, levorin), in aerosols it is possible to add bronchodilators and antihistamines.
Undesirable combination. With streptomycin, monomycin, neomycin and other ototoxic drugs.

Amikacin. Release form. 0.1; 0.25; 0.5 g in bottles; 25% solution in ampoules of 2 ml.
Pharmacodynamics. Semi-synthetic preparation of kanamycin. It has a wide spectrum of inhibitory effects on gram-positive and gram-negative microorganisms. Prevents the formation of a transport and messenger RNA complex by binding to a ribosomal subunit and disrupts protein synthesis. In elevated concentrations, it causes disruption of the barrier functions of cytoplasmic membranes, which leads to the death of microorganisms.
Pharmakinetics. Passes histohematic barriers, penetrates tissues and tissue fluids. It is excreted mainly by the kidneys, creating high concentrations in the urine.
Application. Doses and route of administration are determined individually (intramuscular, intravenous stream or drip). The maximum daily dose should not exceed 1.5 g. Usually a dose of 10 - 15 mg/kg per day is prescribed for 2 - 3 administrations. During use of the drug, it is necessary to ensure that the patient drinks a sufficient amount of fluid. In case of renal failure, the dose is reduced. Select a dose equal to creatinine clearance (CC), i.e. with CC = 40 mg/ml, 40% of the calculated daily dose is prescribed. At 60 mg/ml amikacin is administered once a day, 40 mg/ml - 2 times a day, 10 mg/ml - once every 3 days.
When preparing solutions for intravenous infusion, amikacin is stable for 24 hours at a concentration of 0.25 - 5 mg/ml in formulations containing 5% dextrose or 5% dextrose and 0.2% (0.45%) sodium chloride, or 0. 9% sodium chloride. Amikacin should not be injected in mixture with any other drugs.
Side effects. Damage to the kidneys, auditory and vestibular apparatus, headache, nausea, vomiting, allergic reactions, changes in peripheral blood: anemia, leukopenia, thrombocytopenia.
Contraindications. Acute renal failure, uremia, hypersensitivity to amikacin, pregnancy. Cross-allergic reactions with other aminoglycosides have been described. During lactation, the administration of amikacin may cause cessation of breastfeeding. In case of overdose and poisoning, peritoneal dialysis and hemodialysis are used to eliminate amikacin from the blood; hemosorption is possible. In newborns, replacement transfusion is no less effective.
Rational combination. The simultaneous use of amikacin with penicillins and cephalosporins leads to an enhanced expansion of the spectrum of antibacterial action, but the risk of toxic effects increases.

Junk combination. Amikacin should not be administered with other nephrotoxic and ototoxic drugs. The nephrotoxicity of amikacin is increased by cephalosporins. In vitro, when mixed with B-lactam antibiotics, partial mutual inactivation of the antibiotics occurred. When amikacin is used concomitantly with loop diuretics (eg, furosemide), the risk of ototoxic reactions increases.

Florimycin sulfate. Release form. 0.5 and 1 g in bottles.
Pharmacodynamics and pharmacokinetics: see Kanamycin.
Application. It has a specific bacteriostatic effect on mycobacterium tuberculosis and is used as a reserve drug. It is used to treat various forms and localizations of tuberculosis. Prescribed to patients in whom tuberculostatic drugs have proven ineffective due to mycobacterial resistance or for some other reason.
Apply intramuscularly, inject slowly and deeply. The daily dose for adults is 1 g. Administer daily at 0.5 g 2 times a day (morning and evening) or 1 g once a day for 6 days in a row, taking a break on the 7th day. It is prescribed to children in case of ineffectiveness of other means, in case of chronic destructive tuberculosis. The daily dose for children is 0.015 - 0.02 g/kg (no more than 0.75 g per day).
Side effects and contraindications: see Kanamycin.
Rational combination. In combination with other anti-tuberculosis drugs (PAS, cycloserine, etc.).
Undesirable combination. With streptomycin and other antibiotics that have an ototoxic effect (neomycin, monomycin, kanamycin, amikacin, capreomycin).

Cycloserine. Release form. Tablets and capsules, 0.25 g.
Pharmacodynamics. Cycloserine has a wide spectrum of action, inhibits gram-positive and gram-negative bacteria. Effective against intracellular pathogens of tuberculosis, inhibits mycobacteria resistant to streptomycin, isoniazid, ftivazid, PAS. Acts bactericidal, disrupting cell wall synthesis. Since the drug is similar in structure to O-alanine, it competitively inhibits the B-alanine racemase and O-alanine synthetase systems, as a result of which the formation of the dipeptide B-alanyl-B-alanine, necessary for the construction of the bacterial cell wall, is disrupted.
The drug is considered as a “reserve” anti-tuberculosis drug.
Pharmacokinetics. Cycloserine is well absorbed from the gastrointestinal tract. The maximum concentration in blood plasma is 2-4 hours after oral administration. It does not interact with plasma proteins and penetrates well through the blood-brain barrier. Excreted by the kidneys, in the first day - up to 50%.
Application. It is used to treat patients with chronic forms of tuberculosis in whom previously used drugs have ceased to have an effect. Prescribed orally (immediately before meals) for adults, 0.25 g 2 - 3 times a day; if well tolerated, 0.25 g 4 times a day at a rate of 2.5 mg/kg body weight (no more than 1 g per day). Patients over 60 years of age and with body weight less than 50 kg - 0.25 g 2 times a day. Daily dose for children: at the rate of 0.01-0.02 g/kg, but not higher than 0.75 g per day, with a larger dose prescribed only in the acute phase of the tuberculosis process or when smaller doses are insufficiently effective.
Side effects. There is a toxic effect of the drug on the nervous system: dizziness, headache, convulsions, tremor, disorientation, psychosis with suicidal attempts, paresis, insomnia or drowsiness, paresthesia, neuritis, psychoasthenic manifestations, hallucinations; from the blood side - anemia.
Contraindications. Hypersensitivity, organic diseases of the nervous system, epilepsy, depression, mental disorders, renal failure, alcoholism.
Rational combination. Prescribed with caution with other anti-tuberculosis drugs. To reduce the toxic effect - with pyridoxine (intramuscular 1-2 ml of a 5% solution per day), glutamic acid (0.5 g 3-4 times a day before meals).
Undesirable combination. With sleeping pills, antipyretics and cortisol. When combined with alcohol, the possibility of epileptic seizures sharply increases. Ethionamide and isoniazid increase the neurotoxicity of cycloserine. It is not recommended to prescribe cycloserine before surgery and for a week after it.

Fluoroquinolones

IN last years In phthisiology, progress has emerged in etiotropic therapy associated with the synthesis of drugs from the group of fluoroquinols. In the scientific literature of recent years, such drugs as ciprofloxacin, ofloxacin and lomefloxacin are classified as anti-tuberculosis therapy. Great hopes are placed on the new generation of respiratory fluoroquinolones - levofloxacin and moxifloxacin.
Ciprofloxacin. Release form. Tablets 0.25; 0.5 and 0.75 g. Solutions for infusion in bottles of 50 ml (0.1 g of the drug) and 100 ml (0.2 g of the drug). Solutions for injections in ampoules, solutions for infusions (in 1 ml - 0.002 g of the drug or in 1 ml - 0.1 g) in bottles. Eye drops (1 ml - 0.003 g of the drug), eye ointment (1 g - 0.003 g of the drug).
Pharmacodynamics. Ciprofloxacin has a bactericidal effect on the microbial cell, both during the dormant period and during the growth period. It disrupts DNA biosynthesis, growth and division of bacteria, causes changes in the cell wall and membranes, leading to cell death.
Pharmacokinetics. When taken orally, ciprofloxacin is well absorbed, the concentration in the serum reaches a peak after 1 - 2 hours. When taking 0.5 g it is 2 µg/ml, when taking 0.75 g - 4-5 µg/ml. After intravenous administration, the half-life is 5-6 hours, after oral administration - 3-5 hours. Ciprofloxacin penetrates well and accumulates in the lungs (31% of the concentration in blood plasma), sputum (95%). The drug passes into the milk of a nursing mother in a concentration that is dangerous for the child. Biotransformation occurs in the liver with the formation of low-active metabolites. It is excreted mainly by the kidneys, both unchanged (40 - 70%) and in the form of metabolites. The largest amount is excreted in bile and feces.
Application. Ciprofloxacin is recommended for inclusion as the 3rd, 4th or 5th drug in the treatment of tuberculosis (in combination with other antituberculosis drugs). The tablets are swallowed without chewing with a glass of water. Taking the tablet with food often reduces the therapeutic activity of ciprofloxacin. It is optimal to take the tablet 2 hours after a meal. For tuberculosis, it is recommended to take 0.5 g twice a day or 2 intravenous infusions of 0.2 g, for severe cases - 0.4 g (infusion duration 30 minutes at a dose of 0.2 g and 60 minutes at a dose of 0.4 G). The duration of use of ciprofloxacin for tuberculosis is up to 4 months. When creatinine clearance is less than 20 ml/min, the usual dose is prescribed once a day or divided into two doses.
For AIDS patients with M.avium infection, the inclusion of ciprofloxacin in complex antibacterial therapy is indicated, although the effectiveness of such treatment is not yet high enough.
Side effects. They do not exceed 8% of cases at a dose of 0.5 - 1 g per day. In 60% of cases, the gastrointestinal tract suffers: nausea, vomiting, diarrhea, constipation, abdominal pain, hiccups, flatulence, pseudomembranoepicolitis. Next in frequency are disorders of the central nervous system: headache, anxiety, depression, phobias, nightmares (0.4-14.4%). Ciprofloxacin can cause disturbances in vision, smell, taste, hearing, and sensitivity. Sometimes tachycardia occurs.
In high doses, ciprofloxacin can be nephrotoxic. Cause blood disorders: leukopenia, leukocytosis, anemia, thrombocytopenia, thrombocytosis, changes in prothrombin levels.
In young people, joint damage is possible (accumulation of the drug in cartilage tissue). Ciprofloxacin can cause various types of allergic reactions.
Contraindications. Ciprofloxacin is contraindicated in elderly people, as well as those suffering from epilepsy and damage to the central nervous system, with hypersensitivity to the drug, and with deficiency of glucose-6-phosphate dehydrogenase. It is not recommended to take the drug while driving a car or doing work that requires concentration and the need for quick reactions. The occurrence of photodermatitis, the appearance of a rash or other allergic reactions after taking the first tablet is an indication for discontinuation of the drug. Ciprofloxacin is contraindicated in childhood, adolescence, pregnancy and breastfeeding.
Special instructions. Caution should be used in patients with central nervous system pathology, especially if there is a history of epilepsy or cerebral atherosclerosis (risk of stroke). During treatment you should avoid
ultraviolet and solar radiation, physical activity, control drinking regime, urine pH.
Rational combination. The clearance of ciprofloxacin is increased when combined with rifampicin.
B-lactam antibiotics, aminoglycosides, cephalosporins, macrolides, vancomycin, clindamycin, metronidazole enhance the activity of ciprofloxacin. The synergism of semisynthetic penicillins and quinolones against Pseudomonas aeruginosa has been established.
Compatible with 0.9% sodium chloride solution, Ringer's solution, 5% and 10% glucose solutions, 10% fructose solution.
Undesirable combination. Cimetidine, ranitidine, metronidazole, preparations of bismuth, iron, zinc, ammonium, magnesium, calcium, antacids, laxatives reduce the absorption of ciprofloxacin. When taken orally, these substances can reduce its concentration by 24 - 62%. Iron-zinc-containing preparations include modern multivitamin complexes. Ciprofloxacin is taken 4 hours before or after taking them.
Ciprofloxacin enhances the effect of warfarin and other oral anticoagulants (extends the half-life).
In combination with alcohol, ciprofloxacin reduces the ability to concentrate.

Ofloxacin. Release form. Uncoated tablets of 0.1 and 0.2 g, as well as film-coated tablets of 0.2 g. Solution for infusion of 100 ml in bottles (0.2 g of active drug, 1 ml - 2 mg ofloxacin). Ocuflox - 0.3% solution for use in ophthalmology.
Pharmacodynamics. Ofloxacin has a rapid bactericidal effect due to the inhibition of DNA gyrase. Cell division is inhibited, structural changes in the cytoplasm and death of microorganisms occur. The antibacterial activity of ofloxacin decreases in an acidic environment. The drug has a wide spectrum of action against gram-negative and some gram-positive microorganisms.
Pharmacokinetics. The drug is absorbed by more than 90% from the gastrointestinal tract; peak concentration occurs 0.5-2 hours after oral administration; The half-life is 4.5 - 7 hours. Ofloxacin diffuses well into various tissues and passes the BBB. Biotransformed in the liver. More than 90% is excreted in active form by the kidneys, less than 2% is excreted in the form of metabolites (desmethylofloxacin and M-oxide-ofloxacin). In healthy people, the content of ofloxacin in the cerebrospinal fluid does not exceed 45% of the concentration in the blood, with purulent meningitis - up to 28%, with lymphocytic - 44% (up to 75%). In breast milk, the concentration of ofloxacin is close to the concentration in blood plasma.
Application. Due to its high antibacterial activity and long half-life, oral ofloxacin is prescribed 2 times a day with a 12-hour interval. The drug is taken on an empty stomach, the tablet is not chewed, but swallowed whole, washed down with water. Drinking plenty of fluids is also recommended throughout the day. Ofloxacin should not be taken with food. The drug is not prescribed for more than 2 months. For tuberculosis, at least 0.5 g per day in two doses is recommended.
0.2 g of the drug in a 5% glucose solution is administered intravenously over 1 hour. In ophthalmology: 2 drops of a 0.3% solution in the eye every 2-4 hours for two days, then 4 times a day (up to five days).
Side effects. Allergies and skin reactions associated with exposure to the sun are possible. During treatment with ofloxacin, patients should not be exposed to ultraviolet radiation. Rarely, there may be disturbances from the central nervous system and gastrointestinal tract.
Contraindications. Hypersensitivity to ofloxacin or other quinolones, age under 18 years, pregnancy and breastfeeding. For diseases accompanied by increased convulsive readiness (after traumatic brain injury, stroke, inflammatory processes in the central nervous system, increased intracranial pressure).
Special instructions. With rapid intravenous administration of the drug, a drop in blood pressure may occur. During the treatment period, the patient should not be exposed to sunlight or ultraviolet radiation.

Levofloxacin(tavanik). Respiratory fluoroquinolone is used in patients with drug-resistant acutely progressive tuberculosis (infiltrative, caseous pneumonia), with nonspecific respiratory infectious diseases accompanying tuberculosis.
Levofloxacin has a wide spectrum of activity against all potential pathogens of community-acquired pneumonia, atypical pathogens and gram-negative bacteria. It is characterized by attractive pharmacokinetic parameters: almost absolute bioavailability when taken orally (99%); achieving high and predictable concentrations of bronchial mucosa, fluid lining the bronchial epithelium, alveolar macrophages, polymorphonuclear leukocytes, exceeding the concentration in blood serum. Levofloxacin is available in oral dosage forms, prescribed once daily at 500 mg. Clinically significant hepatotoxicity has not been established when taking levofloxacin. The combination of levofloxacin with isoniazid, pyrazinamide and ethambutol allows one to overcome MBT resistance to isoniazid.

Cephalosporins and macrolides

Cephalosporins are considered promising in the complex treatment of tuberculosis. The antituberculosis activity of third generation cephalosporins (cefotaxime, ceftriaxone, ceftizoxime, ceftazidime, cefoperazone, cefmenoxime, latamoxef, cefixime, cefetameth, cefpodoxime) has been established in vitro. The clinic has shown the effectiveness of the combination of cefotaxime with isoniazid and rifampicin, especially in the early stages of treatment.
In recent years, antibiotics from the macrolide group (azithromycin or sumamed, clarithromycin or crixan, roxithromycin or rulide, josamycin, dirithromycin, midecamycin, etc.) have begun to be used in the complex treatment of patients with tuberculosis. They are usually used
in combination with drugs of group 1 and are designed not so much to suppress Mycobacterium tuberculosis, but to suppress the accompanying pathogenic microflora, which complicates the treatment of a phthisiological patient.
Azithromycin and clarithromycin are the drugs of choice for the treatment of nonspecific respiratory diseases in patients with tuberculosis. These drugs are highly effective against pathogenic nonspecific flora of the respiratory tract and do not interact negatively with isoniazid, pyrazinomide, ethambutol and streptomycin at the pharmacokinetic and microbiological levels. Can be used if MBT is resistant to anti-tuberculosis drugs.

Thioacetazone. Release form. Tablets 0.01; 0.025 and 0.05 g.
Pharmacodynamics. Has bacteriostatic activity against Mycobacterium tuberculosis.
Pharmacokinetics. Well absorbed from the gastrointestinal tract, partially inactivated in the liver, and excreted during the first day, mainly by the kidneys.
Application. Used: limitedly for extrapulmonary forms of tuberculosis, for tuberculosis of the mucous and serous membranes, scrofuloderma, lymphadenitis, specific fistulas. Prescribe the drug orally after meals, washed down with milk. The daily dose for adults is 0.15 g (0.05 g 3 times a day). Children are prescribed 0.0005 - 0.001 g/kg per day (but not more than 0.05 g per day). When treating tuberculous empyema, a 1% sterile suspension (in oil, glycerin) is used.
Side effects. Has relatively high toxicity. Possible headaches, nausea, loss of appetite, inhibition of hematopoiesis (anemia, leukopenia, thrombocytopenia, agranulocytosis), impaired renal function (albuminuria, cylindruria), liver (atrophy, hepatitis), allergic reactions.
Rational combination. With isoniazid, ftivazid, PAS, streptomycin and other anti-tuberculosis drugs.
Undesirable combination. With ethionamide, ethoxide - due to cross-resistance of mycobacteria.

Sodium para-aminosalicylate (PAS). Release form: powder, granules, tablets of 0.5 g, bottles of 250 ml or 500 ml of 3% solution.
Pharmacodynamics. Has bacteriostatic activity against Mycobacterium tuberculosis. The mechanism of action is due to a competitive relationship with para-aminobenzoic acid, which is necessary for the growth and reproduction of mycobacterium tuberculosis. Tuberculostatic activity is low, inferior to isoniazid and streptomycin, and therefore is prescribed in combination with other drugs.
Pharmacokinetics. Well absorbed from the gastrointestinal tract. Maximum concentration in blood plasma after 1 - 2 hours. Part of the drug (50%) binds to plasma proteins. Penetrates into the tissues of internal organs. Penetrates slightly through the blood-brain barrier. It is excreted from the body unchanged by the kidneys (50% within 24 hours).
Application. PAS is used for various forms and localizations of tuberculosis. Orally prescribed in the form of powder, tablets or granules
adults: 9 - 12 g per day (3 - 4 g 3 times a day). Children - 0.2 g/kg per day in 3-4 doses (daily dose no more than 10 g). The drug is taken 0.5-1 hour after a meal, washed down with alkaline mineral water.
PAS solution is injected into a vein by drip. Start with 30 drops per minute and after 15 minutes, in the absence of local reactions, increase the number of drops to 40 - 60 per minute. At the first appointment, no more than 250 ml of solution is administered. If there are no side effects, then pour in 500 ml of solution. Injections are given 5-6 times a week or every other day (alternating with PAS orally); course of treatment - 1 - 2 months.
Side effects. Dyspeptic disorders (appetite suppression, nausea, vomiting, abdominal pain, diarrhea, constipation), hyperacid state of gastric secretions, pain in the heart, allergic reactions, asthmatic phenomena, joint pain, eosinophilia, enlarged and painful liver.
Contraindications. Hypersensitivity to the drug, hypofunction thyroid gland, cardiac decompensation, severe pathology of the kidneys (nephritis), liver (hepatitis, cirrhosis), amyloidosis, gastric and duodenal ulcers.
Special instructions. Caution should be exercised in case of pathological abnormalities of the gastrointestinal tract and thyroid gland.
Rational combination. Used in combination with other anti-tuberculosis drugs - it potentiates their effect, slows down the development of drug resistance and enhances the tuberculostatic effect of drugs. In terms of action, the drug BPAS is close to PAS, the action of which is due to para-aminosalicylic acid being broken off in the body.

Combination drugs.

Recently, combination drugs have been used, when one tablet contains several anti-tuberculosis drugs. In outpatient treatment, this provides great benefits for the patient and medical staff and allows for more precise control of treatment. However, the disadvantage of such forms is the lack of interaction between different groups of drugs and their pharmacokinetics.
Currently, combination drugs such as Mairin and Mairin-P have appeared on the Russian drug market. Mairin contains isoniazid 75 mg, rifampicin 150 mg and ethambutol 300 mg. Mairin-P contains isoniazid 60 mg, rifampicin 120 mg, pyrazinamide 300 mg and ethambutol 225 mg. Mairin-P is prescribed one tablet per 10 kg of body weight 1-2 hours before meals. A maximum daily dose of 5 tablets is recommended.
The drug is contraindicated in case of hypersensitivity to the constituent components, as well as with optic neuritis, acute gout, liver diseases, epilepsy.
Combination drugs from Glaxo Wellcome:
Zukoks(rifampicin/isoniazid and pyrazinamide):

1) film-coated tablets containing 450 mg of rifampicin and 300 mg of isoniazid;
2) tablets containing 750 mg pyrazinamide.
In one package - 15 sets containing 1 film-coated tablet of rifampicin/isoniazid, 2 tablets of pyrazinamide and 1 tablet of ethambutol
Zukoks E(rifampicin/isoniazid, pyrazinamide and ethambutol):
1) film-coated tablets containing 450 mg of rifampicin and 300 mg of isoniazid;
2) tablets containing 750 mg pyrazinamide;
3) tablets containing 800 mg ethambutol.
One package contains 15 sets containing 1 film-coated tablet of rifampicin/isoniazid, 2 tablets of pyrazinamide and 1 tablet of ethambutol.
Zukoks plus(rifampicin/isoniazid):
Film-coated tablets containing 450 mg of rifampicin and 300 mg of isoniazid No. 100 in one package.

According to statistics, tuberculosis is one of the ten leading causes of death worldwide. Thanks to the WHO's End Tuberculosis Strategy, global incidence rates are gradually decreasing (by about two percent per year). And yet, tuberculosis continues to be a complex and significant socio-medical problem.

The death rate from tuberculosis is about 1.7 million people per year.

Before the discovery of antibiotics, tuberculosis was considered an absolutely incurable disease. Currently, many highly effective treatment regimens have been developed. of this disease However, multidrug-resistant forms of tuberculosis pose significant treatment challenges.

Due to the rapid increase in the resistance of Mycobacterium tuberculosis to antibacterial drugs, all treatment should be prescribed exclusively by a phthisiatrician, after a full examination and obtaining cultures for the sensitivity of the pathogen to drugs. Independently adjusting treatment, dosages, regimens and frequency of administration, as well as stopping treatment ahead of time is strictly prohibited.

Treatment of tuberculosis at home with folk remedies is unacceptable. Herbs, infusions, and a popular method on the Internet - dried mole crickets for pulmonary tuberculosis are not effective and cannot replace full-fledged complex anti-tuberculosis therapy.

It is necessary to understand that folk remedies for pulmonary tuberculosis in adults and children can only be used as an addition to the treatment prescribed by a phthisiatrician for a general strengthening purpose. All folk recipes and herbs for tuberculosis can be used after consultation with a phthisiatrician.

Tuberculosis is a curable disease, but a number of factors must be taken into account. Mycobacterium tuberculosis is a widespread bacteria and is characterized by a high level of survivability and the ability to adapt to various environmental factors. In some cases, Koch's bacillus can pass from an active state to a "dormant" state, thereby becoming invulnerable to the effects of antibiotics.

Also, the bacterium can quickly develop resistance to the drugs used.

In particular, a high risk of developing multidrug-resistant tuberculosis (insensitive to most or all known anti-tuberculosis drugs) is observed in patients with HIV and in people who miss timely doses of prescribed medications, stop treatment early, etc.

It is necessary to understand that a complete cure for tuberculosis requires a long period of time and regular use of medications. Early discontinuation of therapy (when the patient’s well-being has stabilized) can cause reactivation of the infection and the development of resistance to the drugs used.

At the same time, if a patient has open tuberculosis, he can infect others with the multidrug-resistant disease (first of all, the patient’s relatives are at risk).

The medicine for tuberculosis is selected by a TB doctor in a hospital. As a rule, complex treatment is prescribed, including four to five drugs. The duration of treatment and the selected regimens are strictly individual.

How long do people live with open tuberculosis?

With timely treatment to the hospital, good sensitivity of mycobacteria and the absence of concomitant pathologies that aggravate the severity of the patient’s condition, the disease is curable.

Treatment of tuberculosis in a hospital

The open form of tuberculosis is highly contagious. In this regard, all treatment takes place in the conditions of an anti-tuberculosis dispensary. The duration of the transition from an open form to a closed form is individual and can range from two to four or more months.

The duration of further treatment is also individual.

Patients with closed forms of tuberculosis can be treated at home. In the future, patients are prescribed supportive and sanatorium treatment.

Disability due to pulmonary tuberculosis

In most cases, the issue of registering disability for tuberculosis is considered if treatment takes more than ten months. The decision to assign a group is made based on the results of a medical and social examination. The disability group assigned to a patient depends on the severity of the disease and the degree of impairment of body functions.

The main indications for referral to MSE (medical and social examination) are:

• duration of treatment more than 10-12 months;
• the appearance of completely or partially irreversible dysfunctions of the body, leading to the patient requiring a change in working conditions;
• severe course of the disease, accompanied by loss of ability to work and/or the need for outside assistance (loss of ability to self-care);
• the need to conduct the next re-examination, change the previously established cause of disability, change the previously assigned group, and receive recommendations regarding further employment.

According to the results of the medical commission, the patient is assigned temporary disability status or a disability group corresponding to the severity of his condition. The assignment of social and labor pensions to patients with tuberculosis is carried out in accordance with the disability group received.

As benefits, patients are entitled to:

• registration of sick leave for a period of nine to twelve months, with guaranteed job retention;
• registration of social insurance benefits;
• provision of free medications from a special list of anti-tuberculosis drugs;
• free spa treatment.

Where can you work after tuberculosis?

Permission to work after suffering from tuberculosis is issued by the VKK (medical advisory commission). Permission to continue studying or return to work is issued subject to:

• complete completion of the course of anti-tuberculosis treatment;
• absence of symptoms of the disease;
• laboratory confirmed absence of bacterial excretion (three times analysis and intervals of two to three months);
• no signs of reactivation of pathological processes.

Patients after tuberculosis are strictly prohibited from working in the following areas:

• healthcare (hospitals, pharmacies, laboratories, etc.);
• Catering;
• education and in preschool children's institutions (kindergartens, schools, institutes, etc.);
• trade.

Also, heavy physical work, work that involves contact with dust, chemicals, coal dust, hot air (work in workshops), night shifts, etc. are contraindicated for patients after tuberculosis.

Patients after tuberculosis are allowed to work as accountants, statisticians, programmers, economists, work at home or in workshops at a tuberculosis dispensary, repair shops, etc.

Treatment of pulmonary tuberculosis in adults

To achieve maximum effectiveness, therapy must be timely, combined, strictly controlled and regular (skipping medications is unacceptable), long-term and sufficiently intense, step-by-step, and also prescribed taking into account the sensitivity of mycobacteria to the antibacterial drugs used.

Anti-tuberculosis drugs (anti-tuberculosis drugs) are usually divided into three groups:

• class A drugs (most effective means) – preparations of isoniazid (tablets for tuberculosis isoniazid are among the most effective and frequently prescribed drugs) and rifampicin;
• class B drugs (moderately effective drugs) - drugs streptomycin, ethambutol, pyrazinamide, ethionamide, kanamycin, cycloserine, viomycin;
• class C drugs (low-effective drugs).

The main drugs used in classical regimens include isoniazid (H), rifampicin (R), ethambutol (E), streptomycin (S), pyrazinamide (Z).

Reserve second-line drugs include thioacetozone (T), prothionamide (Pt), ethionamide (Et), kanamycin (K), amikacin (A), capreomycin (Cap), cycloserine (Cs), rifabutin (Rb), PASK (PAS), fluoroquinolones (Fq), amikacin (Am), etc.

The classic regimen for tuberculosis is the administration of isoniazid, rifampicin, pyrazinamide, ethambutamol and streptomycin (H, R, Z, E, S). In this case, streptomycin is used for a course of no more than two months. Combinations of RHZE or RHZ may also be prescribed. For maintenance courses, a combination of rifampicin and isoniazid is prescribed.

For convenience, combined means are often used:

• Rifater (isoniazid, rifampicin and pyrazinamide);
• rifampicin, isoniazid and ethambutamol and other drugs.

Treatment of tuberculosis in children

Treatment of tuberculosis in children is carried out according to similar regimens (usually HRZE). Dosages are calculated depending on the patient's weight.

In addition to tuberculosis chemotherapy, collapse therapy (creation of artificial pneumothorax and pneumoperitoneum), thoracoplasty, therapeutic fibrobronchoscopy, physical therapy, can be used to treat children and adults. breathing exercises(for tuberculosis, breathing exercises according to Bolotov, etc. can be used).

Surgery for pulmonary tuberculosis

Surgery is used as an addition to chemotherapy. The following can be used to treat tuberculosis:

• thoracoplasty (rib removal);
  pneumolysis (creation of an artificial cavity with a gas bubble, but today it is rarely used);
• surgical interventions on peripheral nerves to change blood and lymph circulation in the lungs;
• resection of affected lungs;
• decortication and pleurectomy;
• cavernotomy;
• surgery to stop pulmonary hemorrhage.

Treatment of tuberculosis after surgery is continued according to previously prescribed chemotherapy regimens.

Treatment of tuberculosis with folk remedies - the most effective schemes

Patients often ask their phthisiatrician whether it is possible to apply mustard plasters for tuberculosis, use herbs, and whether they can replace drug treatment? No. All treatment must be comprehensive, long-term and individual. Without antibiotics, tuberculosis cannot be cured.

Despite the fact that long-term antibiotic therapy is fraught with various complications, in this case it is a justified risk. Early discontinuation of drugs can lead to the development of a completely drug-resistant form of the disease.

No folk remedies can cure tuberculosis. The use of honey with aloe, fish, badger, bear fats, herbal tinctures, etc. are not pathogenetic therapy for tuberculosis. All these remedies can only be considered as a general restorative addition to the antibiotic treatment regimen prescribed by the doctor.

Consequences of tuberculosis

The consequences of the disease are divided into complications of tuberculosis during the active phase of the disease and the consequences of long-term treatment with anti-tuberculosis drugs, as well as surgery (thoracoplasty for tuberculosis is used in severe cases of the disease, as an addition to chemotherapy).

Complications of pulmonary tuberculosis can be:

• development of cardiopulmonary failure;
• the appearance of hemoptysis or pulmonary hemorrhage;
• development of spontaneous pneumothorax;
• formation of tuberculous pleurisy, pleural empyema, atelectasis, etc.;
• addition of extrapulmonary forms of tuberculosis (tuberculous meningitis, damage to mesenteric lymph nodes, etc.)
• disability as a result of residual changes in the lungs (fibrous, fibrous-focal, bullous-dystrophic, cirrhotic, pleuropneumosclerotic, etc.), as well as due to impairment respiratory function after surgical treatment (removal of part of the lung, etc.);
• development of secondary tuberculosis, etc.

It should also be noted that since pathogenetic therapy for tuberculosis can

take more than a year (the duration of treatment depends on the severity of the disease and the sensitivity of Mycobacterium tuberculosis to antibiotics); patients often experience various side effects from long-term and intensive antimicrobial therapy:

• allergic reactions;
• dysfunction of the liver and kidneys;
• jaundice;
• disorders of the gastrointestinal tract;
• heart rhythm disturbances;
• addition of fungal infections;
• problems with conceiving and bearing a child;
• pain in muscles and joints;
• headaches, dizziness;
• noise in ears;
• severe dysbacteriosis;
• weakness;
• steady increase in temperature;
• anxiety, insomnia, depressive disorders;
• changes in the hemogram (leukocytopenia, neutropenia, thrombocytopenia);
• blood clotting disorder, etc.

To reduce the risk of side effects, all antibiotics for tuberculosis should be taken under the control of laboratory indicators of liver function, kidney function, blood coagulation, etc.

Tuberculosis and HIV infection

HIV infection and tuberculosis have a mutually aggravating effect on each other. It should be noted that it was the HIV epidemic at the end of the last century that became the main reason for the rapid increase in the incidence of tuberculosis throughout the world.

At the moment, HIV remains the leading risk factor for the development of tuberculosis in adults and children. According to statistics, the most common infection leading to death in patients with HIV is tuberculosis.

At the same time, there are two options for combining these infections:

• the addition of tuberculosis in patients with HIV or acquired immunodeficiency syndrome (AIDS);
• the addition of HIV or AIDS in patients with active tuberculosis or exacerbation of the process after the end of treatment.

The high incidence of tuberculosis in patients with HIV allows us to conclude that when the immune system is damaged by the human immunodeficiency virus, a latent post-tuberculosis infection is reactivated, which the patient previously had, but was restrained by his own immunity.

Due to damage to the immune system by HIV, as well as impaired differentiation of macrophage cells and the formation of specific granulation tissues, specific tuberculous granulomas may not form in patients with tuberculosis in the later stages of HIV.

The severity of tuberculosis directly depends on the stage of HIV. The fewer CD4 cells in a patient’s blood, the faster and more severe the lung damage.

A feature of the development of tuberculosis in patients with AIDS can be considered its malignant and fulminant development, the rapid progression of lung decay during tuberculosis, a tendency to severe necrotic reactions, as well as the frequent addition of extrapulmonary forms of tuberculosis (tuberculous meningitis, damage to mesenteric lymph nodes, etc.) and ineffectiveness or ineffectiveness of prescribed anti-tuberculosis treatment.

How long do people live with HIV and tuberculosis together?

When antibacterial therapy-sensitive tuberculosis is added to the early stages of HIV, provided that adequate antiretroviral and anti-tuberculosis treatment is provided, patients can live 10, 20 or more years (times vary individually).

For multidrug-resistant forms of tuberculosis or the addition of tuberculosis already in the later stages of AIDS (tuberculosis in the decay stage in such patients has a fulminant malignant course), as well as in case of non-compliance with prescribed medication regimens, the prognosis is unfavorable (less than a year).

Article prepared
Infectious disease doctor A.L. Chernenko

Tuberculosis is a dangerous and contagious disease that is extremely difficult to treat in advanced forms. The earlier the disease is detected, the more favorable the prognosis. At making the right choice anti-tuberculosis drug, active interaction between the patient and the doctor, you can achieve complete recovery in a few months. Otherwise, the process may drag on for years without yielding a positive result.

Types of 1st line drugs

The selection of a drug regimen for the treatment of tuberculosis begins after an accurate diagnosis is made and is based on many factors.

Healthy people who have been in contact with a patient with the open form will be offered preventive therapy, which can be refused.

If the disease has been diagnosed for the first time, it begins to be treated with first-line substances, including synthetic antibacterial drugs and products of natural origin. They:

• have the greatest activity against Koch's bacillus;
• have minimal toxic effects on the body;
• designed for long-term use.

According to doctors and patients, the most effective treatment options are:

1. "Isoniazid".
2. "Rifampicin".
3. "Streptomycin".
4. "Pyrazinamide".
5. "Ethambutol."

They are usually prescribed as the main medications, and to increase effectiveness, 2-3 are used simultaneously. This reduces the likelihood of addiction.

The appearance of various side effects from anti-tuberculosis drugs is quite common.

Second line agents

If taking a medicine from the first group is impossible, resort to additional ones. They are classified as the second row. The substances are characterized by higher toxicity and less impact on the pathogen. Long-term use, which is simply necessary in the treatment of tuberculosis (an average of 10 months), can have an extremely negative effect on the health of the liver and the entire body as a whole. Such medications are prescribed in cases where it is really necessary.

With long-term use of a first-line anti-tuberculosis drug, mycobacteria become resistant to the substances, they no longer work at full strength, so the mentioned drugs are replaced with others.

Second-line drugs include:

• PASK.
• "Prothionamide".
• "Ofloxacin"
• "Kanamycin".
• "Ethionamide."
• "Capreomycin".
• "Amikacin".
• "Cycloserine."
• "Ciprofloxacin"

Sometimes it is necessary to resort to second-line anti-tuberculosis drugs if the patient has been infected with mycobacteria that are already resistant to the main treatment, or allergic reactions to it have been observed.

Depending on the indications, these medications can be used in conjunction with basic medications or separately from them.

Reserve

When the use of both groups is impossible according to indications, patients are prescribed substances that have severe toxicity and have less effect on the mycobacterium than the popular isoniazid and rifampicin.

This group includes:

• "Clarithromycin."
• "Clofazimine."
• "Amoxicillin."
• "Ftivazid".
• "Thioacetazone."
• "Florimicin".
• "Flurenizide".

New drugs

Progress does not stand still. Scientists regularly conduct research to create new anti-tuberculosis drugs.

The list of recent achievements includes:

1. "Perchlozone". Appeared in tuberculosis dispensaries since the beginning of 2013. Compared with other agents that suppress the activity of mycobacteria, it has minimal toxicity and high level efficiency. The exact mechanism of action is still unknown. Application in childhood, during pregnancy and lactation is included in the list of contraindications. Severe renal and liver failure - too. Its cost starts from 20,000 rubles. in Moscow pharmacies.
2. "Sirturo." The active substance is bedaquiline from the group of diarylquinolines. The drug is included in the list of new generation anti-tuberculosis drugs. It was created in 2014, and since then has proven itself well as part of complex therapy for the disease. Positive dynamics were observed after the third month of use. It is expensive, the price per package in different pharmacies ranges from 2000 to 4000 euros.
3. "Mycobutin." A synthetic antibiotic that destroys any form of tuberculosis, including inactive and resistant ones. There is no information regarding the safety of use during pregnancy, lactation and in children, because the study of the substance is ongoing. Costs about 25,000 for a pack of 30 pieces. 1 tablet is prescribed per day.

There are few reviews about new medications; most patients do not risk purchasing them because they are in the development stage and are very expensive. Those who took the risk claim that the disease was defeated in 2-3 months, while standard first-line medications in most cases begin to act no earlier than after 6 months.

Additional medications and differences in classification

• "Repin V6".
• "Laslonvita".
• "Isocomb".
• "Rifter."
• "Protub-3".
• "Tubavit."
• "Rifinag".
• "Pthizoetam B6".
• "Protubetam."
• "Izo Eremfat."

The above classification is the most popular, however, in the International Union Against Tuberculosis, group 1 includes only drugs based on isoniazid and rifampicin.

To the second group they include:

• "Kanamycin".
• "Streptomycin".
• "Cycloserine."
• "Ethambutol."
• "Viomycin."
• "Prothionamide".
• "Pyrazinamide".

They are considered moderately effective.

And in the third group, substances have low effectiveness, these are:

1. "Thioacetazone."
2. PASK.

Based on these different classifications, we can conclude that the principles of treatment of tuberculosis differ significantly. In Russia, the first option is taken as a basis.

"Rifampicin"

Given medicine has a pronounced effect on many gram-positive microorganisms. Active against most mycobacteria, including atypical ones.

When used as a single drug, it quickly becomes addictive and its therapeutic effect is reduced, therefore, for the treatment of tuberculosis, it is combined with other first- or second-line substances, and sometimes used in combination with reserve drugs.

Indications for the use of "Rifampicin" are all forms of tuberculosis, including damage to the brain by mycobacterium.

Not prescribed for:

• severe damage to the liver and kidneys;
• all types of hepatitis;
• various types of jaundice;
• pregnancy in the 1st trimester.

The following may be taken with caution:

• pregnant women in the 2nd and 3rd trimesters;
• small children;
• patients with alcoholism;
• HIV-infected patients receiving proteases.

The medicine can have many side effects, including the following:

1. Gastrointestinal organs (nausea, vomiting, heartburn, constipation, diarrhea, colitis, damage to the pancreas).
2. Endocrine system (dysmenorrhea).
3. Central nervous system (headache, loss of balance, dizziness, impaired coordination of movements).
4. Heart and blood vessels (lowering blood pressure, inflammation of venous walls).
5. Kidney (necrosis of the renal tubules, nephritis, dysfunction of the organ of varying severity).
6. Circulatory system (thrombocytopenia, increased eosinophils, leukopenia, anemia).
7. Liver (hepatitis, increased levels of bilirubin and transaminases).

Some patients experience individual intolerance, which may result in:

• skin rashes;
• Quincke's edema;
• respiratory dysfunction.

In this case, Rifampicin should be replaced.

During therapy, patients may notice that all biological fluids turn reddish. Doctors assure that there is nothing wrong with this. This is not blood, but only a side effect of the drug, which actively penetrates into saliva, urine, and sputum.

Concomitant use with:

• glucocorticoids - their effectiveness decreases;
• isoniazid - toxic effects on the liver increase;
• oral contraceptives - increases the possibility of developing an unwanted pregnancy (which is unacceptable during tuberculosis treatment);
• indirect coagulants - there is a deterioration in the therapeutic effect of the latter;
• pyrazinamide - affects the concentration of rifampicin in serum.

Reviews about the medication are quite different. Some patients note a pronounced effect and rapid recovery, others report numerous side effects, mainly from the liver. Many noticed that the immune system was severely damaged during use, and problems with the growth of fungal flora appeared.

Doctors consider a broad-spectrum antibiotic to be quite effective and claim that a deterioration in well-being can be observed both while taking rifampicin and additional substances. Most often, side effects are observed in people who skip capsule doses.

Indications for the use of rifampicin include the possibility of its use as a prophylactic agent.

"Isoniazid"

Belongs to the group of hydrazides. It has a bacteriostatic effect on all forms of tuberculosis in the active stage and a bactericidal effect on the bacillus at rest.

It can be prescribed as a prophylactic agent to children who have a Mantoux test of more than 5 mm in diameter, or to persons who have been in contact with a patient with an open form of the disease.

Therapy exclusively with Isoniazid causes rapid addiction, so its use as a monotherapy is not recommended.

IN official instructions on the use of "Isoniazid" it is indicated that its use is prohibited for:

• some central nervous system disorders, such as poliomyelitis, epilepsy, acute psychosis;
• acute renal and liver failure;
• the presence of cholesterol plaques on the walls of blood vessels.

For the treatment of patients in early childhood, pregnant and lactating women, the drug is used with caution. The substance is capable of penetrating into all biological fluids and causing developmental delays, neurological and other disorders.

When combined with Rifampicin, the toxicity of both substances increases.

When taken simultaneously with Streptomycin, excretion through the kidneys slows down, so if it is necessary to use such combinations, they must be taken at the maximum possible interval.

The dosage is selected individually in each specific case and depends on:

• forms of tuberculosis;
• presence of resistance;
• general condition of the patient;
• age, gender, weight and other things.

With long-term use, a number of side effects may occur:

• jaundice;
• nausea and vomiting;
• loss of appetite;
• feeling of euphoria;
• hyperglycemia;
• neurosis;
• psychosis;
• dysmenorrhea;
• gynecomastia;
• headache;
• convulsions;
• increased body temperature;
• fever;
• other.

The official instructions for the use of Isoniazid state that if complaints arise related to the start of therapy, a doctor’s consultation is required.

According to many doctors, patients who took Isoniazid in combination with other first-line drugs recovered 6-18 months after the start of treatment, but this was subject to early diagnosis. However, side effects were observed in only 15% of patients.

The patients themselves say that the treatment is quite difficult to tolerate, but it is difficult to assess the effect of a particular drug, since it is rarely prescribed as a monotherapy.

Most of those who used Isoniazid for preventive purposes did not notice a significant deterioration in their health.

"Streptomycin"

Refers to 1st generation aminoglycosides. It is a fairly old broad-spectrum antibiotic. It has been used for many years to treat tuberculosis.

Unlike other products, it is of natural origin. It was obtained from the waste products of certain types of microscopic fungi.

The substance is used by injection due to poor absorption from the gastrointestinal tract. It is excreted unchanged from the body. It disrupts the synthesis of protein molecules of mycobacteria, suppresses their reproduction and destroys the infection.

The dosage is selected individually. The average is 15 mg per 1 kg of weight. Injections can be given 1-2 times a day. It is not suitable as the main drug; to successfully eliminate the infection, it is combined with other medications, for example Rifampicin or Isoniazid.

Despite the natural process of obtaining the medicine, when taking it, unwanted reactions may occur from various body systems. This could be a malfunction:

• auditory and vestibular apparatus;
• central and peripheral nervous system;
• digestive organs;
• genitourinary system.

Sometimes individual intolerance to "Streptomycin" is observed.

The medicine began to be actively used for the treatment of tuberculosis in 1946. In those days, it was possible to cure a huge number of people, but then the bacteria began to acquire resistance, so at the moment the use of Streptomycin alone does not give the desired effect.

For this reason, there are few reviews about the drug; some consider it effective, others useless. Doctors often include such injections as part of complex therapy for tuberculosis and often observe positive dynamics.

Sometimes the use of Streptomycin has to be abandoned if patients experience hearing impairment, which can lead to complete deafness.

"Pyrazinamide"

A synthetic antibacterial agent used to treat various forms of tuberculosis. Produces a bacteriostatic and bactericidal effect.

The drug "Pyrazinamide" is produced exclusively in the form of tablets, because the best effect is observed when interacting with an acidic environment. Once in the body, they penetrate directly into the lesions, where they affect pathogens.

Most often, phthisiatricians prescribe it in cases where the patient has already developed resistance to Rifampicin and Isoniazid.

It is not used for:

• gout;
• hyperuricemia;
• epilepsy;
• increased nervous excitability;
• decreased thyroid function;
• severe disorders of the liver and kidneys;
• pregnancy.

Like any other anti-tuberculosis drug, Pyrazinamide is poorly tolerated by patients. According to them, during treatment they noted the following disorders:

• Enlargement and pain of the liver, development of various pathologies of the organ.
• Exacerbation of peptic ulcers.
• Loss or deterioration of appetite.
• Nausea and vomiting.
• Iron taste in mouth.

In addition, taking pills can cause disturbances in the functioning of the nervous and hematopoietic systems and provoke various allergic reactions - from skin to systemic.

The most pronounced anti-tuberculosis effect is observed when taken simultaneously with:

• "Rifampicin".
• "Isoniazid".
• Fluoroquinolones.

According to doctors, such combinations can quickly give positive dynamics, provided that all prescribed medications are taken regularly. Frequently skipping pills can cause more severe side effects and lack of results.

"Ethambutol"

A synthetic antibacterial agent that acts exclusively on the active form of the disease. It has a bacteriostatic effect, i.e. it suppresses the reproduction of the pathogen.

Not effective as a prophylactic agent for persons in contact with the patient or for patients with suspected inactive tuberculosis.

Included in most therapeutic regimens for eliminating Koch's bacillus, especially if addiction has developed to the main remedies.

The drug "Ethambutol" is not used for:

• presence of resistance;
• optic neuritis;
• retinopathy;
• other inflammatory eye diseases.

In pediatric practice, it can be used from 2 years of age.

Among the most common side effects, patients note:

• nausea and vomiting;
• abdominal pain;
• dizziness;
• sleep disorder;
• increased amount of sputum;
• increased cough;
• the appearance of a rash and other allergic reactions.

PASK. "Cycloserine"

They belong to the 2nd row of anti-tuberculosis drugs and have less pronounced activity against mycobacteria.

Their use is resorted to in case of addiction to first-line anti-tuberculosis drugs or as part of complex therapy. Compared to basic medications, their prices are significantly higher and are not suitable for long-term treatment for everyone.

Capsules "Cycloserine", PAS and other similar drugs are prescribed in cases where the use of other medications is impossible.

They are not prescribed for the treatment of pregnant women and young children, as their negative impact on the formation of the fetus and the further development of the baby has been proven.

Severe renal and liver failure is also included in the list of contraindications.

Patients who have used PAS for a long time note the appearance of:

• goiter caused by decreased thyroid function;
• nausea, vomiting, heartburn;
• malfunctions of the liver and kidneys;
• jaundice;
• swelling;
• fever;
• other complaints.

When taking Cycloserine capsules, disruption of the thyroid gland is not observed, but other side effects may be present. Also, the anti-tuberculosis drug has a pronounced effect on the nervous system, causing:

• Insomnia.
• Nightmarish dreams.
• Aggression, irritability.
• Euphoria.
• Psychoses.
• Cramps.

Concomitant use with alcohol increases side effects from the central nervous system.

"Isoniazid" and "Cycloserine" lead to drowsiness and lethargy. When combined with PAS, its activity increases.

Many years ago, the diagnosis of tuberculosis sounded like a death sentence. Today everything has changed. Scientists have created many effective medications to treat the infection. The interaction of anti-tuberculosis drugs makes it possible to obtain positive dynamics several months after the start of therapy. Despite their toxicity, they will help to completely get rid of the disease and give a person a second chance.

For effective treatment and preventive measures use anti-tuberculosis drugs - specific antibacterial agents intended for chemotherapy in patients with consumption.

Classification of funds

For various forms of the pathological process, drugs for pulmonary tuberculosis are used, which have a high bacteriostatic effect against the causative agent of the disease.

Anti-tuberculosis drugs are divided into 3 groups: A, B, C. In many cases, first-line (main) substances are prescribed for therapy:

• Rifampicin;
• Pyrazinamide;
• Isoniazid;
• Ethambutol;
• Streptomycin.

If resistant forms of the tuberculosis pathogen appear and there is no effect of treatment, the patient is prescribed second-line (reserve) drugs:

• Ethionamide;
• Cycloserine;
• Amikacin;
• Capreomycin.

• Ofloxacin;
• Levofloxacin.

If the disease has gone too far, it is advisable to include bacteriostatic agents in the list of necessary means:

• Ethionamide;
• Terizidone.

Group 5 of drugs includes drugs with unproven activity:

• Amoxiclav;
• Clarithromycin;
• Linezolid.

It is necessary to follow certain rules when prescribing anti-tuberculosis drugs - the classification of drugs makes it easier to select the necessary drugs.

After diagnosis, taking into account the symptoms of the disease, the patient is registered at the dispensary. In the first accounting group, patients with an active form of tuberculosis are observed and treated.

There are several subgroups that include patients with destructive pulmonary tuberculosis who release bacteria into the environment. The chronic course of the disease of any localization is subject to careful monitoring and treatment, especially in the case of the development of cavernous and cirrhotic processes. After chemotherapy, residual changes in the lung tissue remain. Patients are under medical supervision.

A fairly common phenomenon is human contact with a source of tuberculosis infection. The patient must regularly visit the doctor to identify the primary infection. Children and adolescents with a tuberculin test are regularly examined by a TB specialist.

Treatment of lung disease is carried out in compliance with the basic principles:

• early use of effective chemotherapy;
• complex use of drugs;
• prescribing medications taking into account the characteristics of the pathogen;
• regular monitoring of the therapy process.

The patient is prescribed specific, pathogenetic and symptomatic treatment.

Vital medications

Tuberculosis tablets destroy sensitive mycobacteria, so they are used in the intensive care phase to stop the release of the pathogen into the environment. First-line drugs are prescribed to be taken for 2 months (at least 60 daily doses) for patients who are newly diagnosed with tuberculosis.

For treatment, 4 drugs are prescribed:

• Isoniazid;
• Rifampicin;
• Pyrazinamide;
• Ethambutol.

In an HIV-infected patient, Rifampicin is replaced with Rifabutin. To continue therapy for several months, the main drugs for the treatment of tuberculosis are prescribed - Isoniazid and Rifampicin. Often the patient is recommended to take 3 first-line drugs against tuberculosis - Isoniazid, Pyrazinamide and Ethambutol. The course of therapy lasts 5 months.

The tuberculosis treatment regimen is recommended for patients who have interrupted therapy or are undergoing a repeat course. If resistance of the tuberculosis pathogen is diagnosed, daily doses of drugs are prescribed in 1 dose to establish their high concentration in the blood serum.

The anti-tuberculosis drug Pyrazinamide is prescribed to the patient if there are contraindications to the use of Ethambutol. The dose of the medication is determined taking into account the age and weight of the patient; Children and adolescents are prescribed the drug for medical reasons.

Combined products: advantages and disadvantages

Treatment of pulmonary tuberculosis in adults is carried out with the help of medications designed to control their intake and prevent overdose. Combined anti-tuberculosis drugs include 3-5 components.

The following medications are used in outpatient practice:

• Rifinag;
• Phthisoetam;
• Rimcourt;
• Prothiocomb.

The main components of the combined drugs are isoniazid, ethambutol, vitamin B6. The medicine Lomecomb consists of 5 ingredients that influence the course of the acute process.

Combined drugs are prescribed to patients with tuberculosis diagnosed for the first time, as well as with severe resistance to isoniazid and rifampicin.

In the tuberculosis dispensary, therapy is carried out using the drugs Lomecomb and Protiocomb, which increase the effectiveness of treatment in the event of a progressive form of the disease. The main disadvantage of combined substances is the presence of side effects.

Reserve medicines

If it is not possible to achieve the effect of treatment with first-line drugs, the patient is prescribed backup drugs:

• Cycloserine;
• Ethionamide;
• Kanamycin;
• PASK.

Their use gives good results in the treatment of the disease.

For the treatment of resistant dosage forms, Levofloxacin from the group of fluoroquinolones is used. The daily dose is set individually for each patient, taking into account the pharmacokinetics of the drug. If the patient does not tolerate Levofloxacin well, Avelox is prescribed, an antibiotic that has a universal effect.

Treatment of the intensive phase of pulmonary tuberculosis is carried out using combined drugs that cause the development of side effects. Levofloxacin is prescribed simultaneously with medications that eliminate its side effects on the nervous system.

PAS has a negative effect on the stomach and intestines. The patient is recommended to take the medicine with water mixed with cranberry juice. Taking PAS is discontinued if the patient develops joint pain.

Side effect

The doctor monitors concomitant reactions during treatment chemicals. The patient is prescribed blood and urine tests, ALT and AST in the blood are determined, the presence of creatinine is determined, and a doctor’s examination is recommended during treatment with aminoglycosides.

Side effects of anti-tuberculosis drugs are manifested by unpleasant symptoms. Isoniazid causes headache, irritability, and insomnia. The patient's optic nerve is affected, palpitations, heart pain, and symptoms of angina pectoris occur. Rifampicin (Ref) is difficult to tolerate by patients, because causes serious complications from the nervous system:

• visual impairment;
• unsteady gait;
• lack of correct orientation in space.

Often the patient develops an allergic reaction, accompanied by muscle pain, weakness, herpetic rashes, and fever.

Therapy with anti-tuberculosis drugs has a negative effect on digestive system. The patient complains of nausea, vomiting, pain in the stomach and liver. Kanamycin sulfate causes dyspeptic disorders, neuritis and the appearance of blood in the urine.

How to take medications

To treat pulmonary tuberculosis, a specific therapy regimen is prescribed. The medicine is taken in the dose recommended by the doctor, taking into account the stage of development of the disease.

The treatment regimen includes substances that enhance the effect of anti-tuberculosis drugs, for example, glutamyl-cysteinyl-glycine disodium. Patients with HIV infection receive therapy for 9-12 months.

Levofloxacin is prescribed if the causative agent of the disease is resistant to drugs of the main group. The antibiotic is taken continuously for 24 months. It has a bactericidal effect, but is not recommended for patients with kidney disease. The medicine is non-toxic, so patients tolerate it well.

For the treatment of adults, aminoglycosides are prescribed in combination with penicillins. Amikacin is administered intramuscularly, intravenously. The doctor prescribes the dose of the drug individually. During treatment, the patient is given plenty of fluids to drink. Amikacin should not be mixed with other drugs.

Patients with diabetes mellitus during treatment with Rifampicin and Isoniazid, blood glucose levels should be monitored.

PASK tablets are taken according to the instructions, washed down with milk or alkaline mineral water. Fraction ASD 2 is recommended for patients with severe tuberculosis.

Therapy with Dorogov's stimulant

If resistance to 1st and 2nd line drugs has developed, some patients use unconventional methods of treatment. For pulmonary tuberculosis, the drug ASD has proven itself to be an antiseptic and stimulant that restores the cells of the diseased organ and the immune system.

Treatment with the ASD fraction improves lung function, increases the number of enzymes and restores the permeability of the cell membrane. As a result of the action of the drug, metabolism in the tissues of the diseased organ is activated. The medicine has an unpleasant odor, so before taking it it is mixed with juice or kefir.

Pulmonary tuberculosis in adults and children is treated according to a specific regimen. The dose of the drug is prescribed by the doctor. The duration of therapy does not exceed 3 months. In some cases, the patient develops an allergic reaction; in patients with unstable mental health, uncontrollable agitation occurs. In this case, the drug is discontinued.

The fraction is contraindicated for pregnant and nursing mothers. Modern pharmacology considers ASD as a natural complex, similar in structure to the substances that make up the human body.

New drugs

Among the best drugs is the effective drug SQ109, used to treat patients with pulmonary tuberculosis. After using it for 6 months, it is possible to stop the release of the pathogen into the environment. The medicine is safe and well tolerated by patients. SQ 109 is prescribed for combination therapy in combination with Isoniazid, Bedaquiline and Ampicillin.

New anti-tuberculosis drugs belong to the 2nd line drugs and have an antibacterial effect. The patient is prescribed medications:

• Bedaquiline;
• Linezolid;
• Sparfloxacin;
• Ethionamide.

New anti-tuberculosis drugs help to successfully combat primary or secondary drug resistance of Mycobacterium tuberculosis. Among the new drugs for tuberculosis, the drugs BPaMZ and BPaL, used for the treatment of tuberculosis of various localizations, have an effective effect. The drug BPaL is used to treat illness caused by resistant forms of the pathogen.

New drugs against tuberculosis are undergoing clinical trials and significantly reducing the duration of therapy. The drug Prothiocomb reduces the number of tablets needed to take during the day several times, and its effectiveness is not inferior to the effect of single drugs.

Alcohol compatibility

Patients who abuse alcohol often develop tuberculosis. Treatment drinking man long-term, accompanied by severe complications. For alcohol dependence, a patient with tuberculosis is prescribed drugs such as:

• Streptomycin;
• PASK;
• Rifampicin.

If during treatment the patient allows himself a small dose of alcohol, gastritis often develops after taking the medicine, increasing the load on the liver.

Amikacin in combination with alcohol causes nausea and vomiting. Symptoms of depression of the nervous system occur after the simultaneous use of the antibacterial drug Amikacin and strong alcoholic beverages. A bad habit and unauthorized cessation of treatment often lead to a decrease in the body’s defenses and the development of the cavernous form of tuberculosis.

The combination of the following drugs with alcohol is extremely dangerous: Rifadina, Isoniazid, Ethionamide. After drinking small doses of alcohol, the patient develops symptoms of acute hepatitis. The simultaneous use of anti-tuberculosis drugs and alcohol disrupts the function of the pancreas and increases inflammation of the respiratory tract.

Contraindications for use

Anti-tuberculosis drugs do not always benefit the patient. Isoniazid is not prescribed to patients with liver disease, epilepsy and reactive psychosis. PAS causes exacerbation of gastric and duodenal ulcers, glomerulonephritis, nephrosis, hypothyroidism.

In the vast majority of cases, Amikacin is not recommended for patients suffering from pathologies of the organs of vision and hearing, or renal failure.

Sometimes patients complain of an allergic reaction during treatment with anti-tuberculosis drugs.

• Tavegil;
• Diazolin;
• Zaditen.

Ciprofloxacin is not prescribed to elderly people, pregnant women, or those with hypersensitivity to the drug. In tuberculosis dispensaries, infusion therapy begins with a jet injection of an antibiotic.

• thrombophlebitis;
• hypertension of II and III degrees;
• diabetes mellitus;
• hemorrhagic diathesis;
• circulatory failure of II and III degrees.

During breastfeeding, taking Rifampicin and medications from the fluoroquinolone group is contraindicated.

Preventive action

A patient takes pills to prevent tuberculosis. Streptomycin is prescribed to pregnant women, patients suffering from pathologies of the brain, kidneys, and heart. Tuberculosis is prevented in children and adults using the drug Metazide. The drug has a bactericidal effect, but sometimes causes side effects:

• dizziness;
• nausea;
• vomiting;
• diarrhea;
• allergic reaction.

The medicine is taken simultaneously with vitamins B1 and B6. The drug is contraindicated in patients with diseases of the nervous system.

Prevention of tuberculosis in adults is carried out using a broad-spectrum antibiotic. Cycloserine is taken as prescribed by a doctor. The medicine is contraindicated for people with mental disorders who abuse alcohol.

A drinking patient experiences headache, tremor, disorientation, and increased irritability. When taking an antibiotic, you must be careful because... the patient may experience seizures. In this case, the patient is prescribed sedatives and anticonvulsants.

The success of treatment of pulmonary tuberculosis depends on the exact implementation of the doctor’s recommendations and adherence to the treatment regimen.

Tuberculosis belongs to the group of infectious diseases. The causative agent is a species of mycobacterium with high viability. They do not manifest themselves for a long time, becoming more active when favorable conditions. According to statistics, a third of the world's population is a carrier of the Koch bacillus. A universal cure for tuberculosis has not been invented, and the problem of epidemics in a number of countries remains unresolved. However, existing drugs to treat tuberculosis help reduce the incidence.

Infection occurs as a result of a sharp decrease in immunity. The development of the disease is provoked by poor living conditions, poor nutrition, and chronic pathologies. More often, mycobacteria affect the respiratory system. But they also apply to the digestive, skeletal and other systems of the body. Depending on this, appropriate drug treatment for tuberculosis is prescribed.

What are anti-tuberculosis drugs

The effectiveness of recovery is determined by a set of measures. First of all, it includes drugs for tuberculosis. These chemotherapy drugs are used to both treat and prevent the disease. Tuberculosis drugs are divided into groups based on their clinical effectiveness:

1. The main means of high activity are against mycobacteria with low toxicity.
2. Reserve drugs are drugs for tuberculosis, for multidrug-resistant types of the disease.

Anti-tuberculosis drugs prevent the growth and reproduction of bacteria. At a certain concentration, some destroy the pathogen. Medicines for pulmonary tuberculosis are selected taking into account the form of the disease and the resistance of mycobacteria to a particular drug.

Photo 1. Mycobacterium tuberculosis has an oblong shape, which is why they are also called the tuberculosis bacillus.

Types of drugs for tuberculosis

The treatment regimen includes drugs belonging to one of the groups. The international classification classifies effective drugs against tuberculosis in the first group. They are prescribed to prevent relapse, for prophylaxis. Their use began in 1952.

Isoniazid

The mechanism of action is based on the fact that the drug blocks the synthesis of mycolic acid, preventing the spread of infection. Active against intracellular and extracellular bacteria. It is considered an effective medicine against tuberculosis. Helps cope with the disease at any age, used for treatment and prevention. The drug is contraindicated in patients with epilepsy, atherosclerosis, and poliomyelitis.

A popular medicine against tuberculosis, it exhibits high activity in the affected area. After administration, the active substance is rapidly absorbed. It concentrates in sputum, kidneys, liver, and lungs. The risk of passage into breast milk does not allow the use of the drug during lactation. Rifampicin should not be used if the patient has a diseased liver.

Photo 2. Rifampicin is a broad-spectrum antibacterial agent used in anti-tuberculosis therapy.

Pyrazinamide

The bactericidal effect of this drug for the treatment of pulmonary tuberculosis is less pronounced. However, it has a sterilizing effect, manifesting itself at the site of infection. Affects slowly reproducing bacteria depending on their resistance. Prescribed for any form of disease. Prohibited for liver failure.

An effective medicine for the treatment of tuberculosis with a bacteriostatic effect. The active substance ethambutol hydrochloride is absorbed gastrointestinal tract and is excreted through the kidneys. The treatment course lasts 9 months and consists of several stages. The initial dosage is 15 mg per kilogram of patient weight. Take Ethambutol once a day. Gradually the dose is increased to 30 mg per kilogram of weight. For patients with renal failure, the medicine is prescribed depending on creatinine clearance. Contraindications for use are gout, diabetic retinopathy, and pregnancy. Taking Ethambutol can lead to decreased vision; it is not recommended for use for cataracts and inflammatory processes in the eyes.

Photo 3. Ethambutol is used in the treatment of tuberculosis because it has a strong bacteriostatic effect on the causative agent of the disease.

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Streptomycin

Broad spectrum antibiotic. It is prescribed by a doctor taking into account the characteristics of the course of the disease. The duration of the therapeutic course is determined individually. The maximum daily dosage of medication for the treatment of pulmonary tuberculosis is 4 grams. Contraindications for use: renal failure, cardiovascular diseases, myasthenia gravis, brain disorders. Pregnant and lactating women with tuberculosis are prohibited from taking Streptomycin.

The range of drugs for tuberculosis included in the second, reserve, group is wider. They are prescribed when it is impossible to use drugs from the first group and when previous therapy has not given a positive result.

Photo 4. Streptomycin, a broad-spectrum antibiotic, is used to treat tuberculosis diseases in the form of injections.

Cycloserine

Used for more than half a century. Today, the product is obtained synthetically. The drug has a bactericidal and bacteriostatic effect. It has high absorption, which allows it to quickly reach maximum concentration in body fluids and tissues. Able to pass into breast milk. For this reason, it is contraindicated during breastfeeding and pregnancy. Prohibited for children. Taking medication for tuberculosis in adults causes headaches, drowsiness, and irritability. For mild forms of tuberculosis, the drug is prescribed at any stage of the disease.

Photo 5. Antibacterial agent Cycloserine inhibits the growth of tuberculosis pathogens that are resistant to other drugs.

Kanamycin

A popular drug with high activity against bacteria various types. Scheme of use for tuberculosis: for adults - 1 g per day once for six days, for children - 15 mg per day. On the seventh day there is a break. The duration of the course and its duration is determined by the doctor. Kanamycin is not prescribed in combination with antibiotics with nephrotoxic and ototoxic effects. The drug is contraindicated for people with hearing problems, diseases of the digestive system and pregnant women.

Photo 6. Kanamycin solution is used to treat tuberculosis with drug-resistant pathogens.

Metazide

Derivative of isonicotinic acid hydrazide. The mechanism of action of this drug is the ability to damage the membrane of pathogenic bacteria, causing their death. The daily dose is 2 g of the drug for adults and 1 g for children. It is divided into 2-3 doses. The medicine is used for any form of tuberculosis. It is prohibited for patients who have central nervous system diseases, renal failure, or heart disease. During treatment for tuberculosis, check the condition of the fundus of the eye.

Photo 7. Metazide has a bactericidal effect against actively reproducing mycobacterium tuberculosis.

Ethionamide, Prothionamide

The structure of these drugs is largely similar. Providing a bacteriostatic effect in the affected area, they inhibit the proliferation of tuberculous mycobacteria. The drugs are used in the treatment of patients over 14 years of age. The ability of drugs to pass into breast milk has not been established. To prevent the occurrence of undesirable consequences, the drugs are not used during lactation.

Photo 8. Prothionamide is available in tablet form and is used in conjunction with other anti-tuberculosis drugs.

Thioacetazone

A synthetic antibiotic effective against tuberculosis. Take it exclusively after meals, with plenty of water. During treatment, it is important to monitor kidney activity. If agranulocytosis is detected, stop taking the drug. Thiocetasone should not be used to treat tuberculous meningitis.

P reparations	Daily intake		Reception 2 times a week		Maximum daily dose
	Children	Adults	Children	Adults	Children	Adults
Isoniazid	10-20 mg/kg	5 mg/kg	20-40 mg/kg	15 mg/kg	0.3 g	0.3 g
10-20 mg/kg	10 mg/kg	10-20 mg/kg	10 mg/kg	0.6 g	0.6 g
Streptomycin	20-40 mg/kg	15 mg/kg	25-30 mg/kg	25-30 mg/kg	1 g	1 g
15-25 mg/kg	15-25 mg/kg	50 mg/kg	50 mg/kg	2.5 g	2.5 g

The table shows the dosages of anti-tuberculosis drugs depending on the age category of the patient and the chosen tuberculosis strategy.

Features of the use of drugs for tuberculosis

An integrated approach will ensure complete recovery. Drug treatment tuberculosis is accompanied by measures aimed at strengthening the immune system. The therapeutic complex implies that many effective drugs for tuberculosis will be used. The drugs have certain actions, which help to more effectively cope with the disease. Taking medications for tuberculosis cannot be interrupted in order to avoid the development of pathogen resistance to the drug. A full course of treatment is carried out, during which it is important to adhere to the medication regimen.

Photo 9. When treating tuberculosis, it is important to strictly adhere to the regimen of taking anti-tuberculosis drugs.

Side effects of tuberculosis drugs

Drugs for the treatment of pulmonary tuberculosis are toxic. Most of them cause various side effects. These can be both toxic complications and an allergic reaction. In the first case, the duration of treatment, dosage, and individual characteristics of the body matter. After taking the medicine, the patient’s condition deteriorates and the functioning of internal organs is disrupted. Allergic manifestations are more often observed after taking antibacterial agents. Expressed in the form of rashes on the skin, itching, rhinitis, Quincke's edema. Anaphylactic shock is especially dangerous and can be fatal. An allergic reaction occurs in response to an antigen drug and metabolic products. Uncontrolled use of anti-tuberculosis drugs can undermine human health.

Photo 10. Skin itching may be a symptom of an allergy to the anti-tuberculosis drug the patient is taking.

It is possible to avoid negative consequences from taking medications. Treatment is carried out under the supervision of a doctor who takes a medical history and conducts a full examination, taking into account laboratory tests and fluorography. They are made by any clinic or tuberculosis hospital. After this, it is determined which medications to treat tuberculosis in a particular case. A treatment regimen is developed based on the clinical course of the disease. The drugs are prescribed in small doses, which are increased over time. Minimize side effects chemical medications will help any folk remedy from tuberculosis. When choosing it, consultation with a phthisiatrician is required.