Tuberculosis-Medicines For Treatment,Dosage,Risks,Side Effects.
Tuberculosis is a disease that affects the lungs, In treating tuberculosis (TB), it is very important that you always use 2,3 or even 4 anti-tuberculosis medicines at the same time. If only one medicine is used, the TB bacteria becomes resistant to it and make the disease hard to treat.
Tuberculosis must be treated for a long time, usually 6 to 9 months or longer. The length of treatment depends on what combination of medicines is used. To keep tuberculosis from coming back again, the long term treatment is extremely important.
Tuberculosis of the lungs is a chronic (long-lasting), contagious (easily spread) disease that anyone can get. But it most often strikes persons between 15 and 35 years old, especially those who are weak, poorly nourished or live with someone who has the great.
Tuberculosis is curable. Yet thousands die needlessly from this disease every year. Both for prevention and cure, it is very important to treat tuberculosis early. Therefore, you should know the signs of tuberculosis and be on the lookout for them.
MOST FREQUENT SIGNS OF TUBERCULOSIS
- Chronic cough, especially just after waking up.
- Mild fever in the afternoon and sweating at night.
- There may be pain in the chest or upper back.
- Chronic loss of weight and increasing weakness.
- A person with black skin tends to become lighter in complexion. This is most noticeable on the face. If tuberculosis is suspected, compare the person’s skin color with that of the parents or other children in the family.
IN SERIOUS OR ADVANCED CASES
- Coughing up blood (usually a little but in some cases a lot).
- Voice grows hoarse (very serious).
Tuberculosis is in the lungs in more than half the cases; but it can affect any part of the body. In young children, the cough may only come late. Do not wait for it. Look instead for :
- Steady loss of weight.
- Frequent fever.
- Light skin color.
- Swellings in the neck (lymph nodes) or the abdomen.
In children there is also the danger of meningitis.
IF YOU THINK YOU MIGHT HAVE TUBERCULOSIS :
Call for medical help. At the first sign of tuberculosis, go to a health center where the workers can give you a skin test, take an x-ray, examine the stuff you cough up (phlegm or sputum) to see if you have TB or not.
Many governments give the medicines free. Ask at the nearest health center. You will probably be given 2 or 3 of the following :
- Streptomycin injections.
- Isoniazid (I.N.H) pills.
- Pyrazinamide pills.
- Thiacetazone pills.
- Ethambutol pills.
It is very important to take the medicines as directed. At least 2 must be taken at the same time.
Continue taking the medicines until the health worker tells you that you are cured. Do not stop taking the medicines just because you feel better. To cure tuberculosis completely usually takes 6 months to more than one year.
Eat as well as possible : Foods rich in proteins and vitamins, as well as energy foods. Rest is very important; you should stop working and take it easy until you begin to get better.
Tuberculosis in any other part of the body is treated the same as TB of the lungs. This includes tuberculosis in the glands of the neck, TB of the abdomen and TB of a joint like the knee or the backbone. Occasionally, the latter may need surgery to prevent paralysis.
Tuberculosis of the lungs is very contagious. Persons who live in the same house with someone who has TB, especially children, run a great risk of catching the disease.
IF SOMEONE IN THE HOUSE HAS TB
- If possible, see that the whole family is tested for TB (Tuberculin testing).
- Have the children vaccinated against TB.
- Everyone, especially the children should eat plenty of nutritious food.
- The person who has TB should eat and sleep separately from the children, if possible in a different room, as long as he has any cough at all.
- A person with TB should be careful to cover his or her mouth when coughing and should never spit on the floor.
- Try to have all the family, children and adults weighed regularly, if possible once a month, till the danger is past.
TB in family members often starts very slowly and quietly. Suspect it if :
- There is steady weight loss.
- There is fever for two weeks or more.
- The person becomes lighter in complexion.
- A cough develops that lasts for more than 2 weeks.
If any one of those signs appears, then take the person to the health center at once for confirmation of TB by tuberculin testing, sputum or chest X-ray.
NOTE : A person who no longer has TB will not spread it.
Some medicines for tuberculosis are expensive (rifampin, pyrazinamide, ethambutol). Many government have programs that test for tuberculosis and give medicine free or at low cost. Experienced local advice is important because treatments change makes bacteria becomes resistant. Also some programs give medicines only twice a week in higher doses.
Isoniazid (INH) should always be used in the treatment of TB. Rifampin is a very effective medicine that should be used whenever possible especially until a sputum test comes out negative. Ethambutol and Streptomycin are also often used to treat TB. Taking pyrazinamide with Isoniazid and rifampin can shorten the time of treatment.
Thiacetazone is an inexpensive Tuberculosis medicine but it can cause side effects in a proportion of cases. These can be serious unless it is picked up at earliest stage. If the medicines causes itching, yellowing of the skin and eyes (jaundice), stomach pains, make sure you see a health worker for possibly changing the dosage. If blisters occur, you should stop taking the medicine until you can see a health worker.
Avoid alcohol when taking TB medicines especially when taking Isoniazid.
RECOMMENDED TREATMENTS FOR TUBERCULOSIS
Use one of the following combination of medicines depending on which are available, affordable and recommended in your area.
- You can give isoniazid, rifampin, ethambutol and pyrazinamide for two months. Then stop taking pyrazinamide but continue using rifampin,isoniazid and ethambutol for another four months.
- Give isoniazid, rifampin and ethambutol for nine months.
- Combine isoniazid, rifampin, streptomycin and pyrazinamide for two months. Then give isoniazid with ethambutol, streptomycin or possibly thiacetazone for six months. This treatment has the advantage of being cheaper because less rifampin is needed.
- If rifampin is not available or is too expensive, give isoniazid, ethambutol and streptomycin for two months or until a test shows the sputum is negative. Then continue to give streptomycin for two more months and give isoniazid and ethambutol for one year.
- Pregnant women with Tuberculosis should seek experienced medical advice. Otherwise, give isoniazid and either ethambutol, rifampin or thiacetazone for eighteen months. Also give 50 mg of vitamin B6 (pyridoxine) a day. Do not give pyrazinamide or streptomycin during pregnancy.
This medicine often comes in tablets of 100 or 300 mg. It is the most anti-tuberculosis medicine. To treat TB, it must always be given with at least one other anti-TB medicine whenever possible. For prevention, it can be given alone.
RISKS AND PRECAUTIONS OF ISONIAZID (INH)
Rarely isoniazid causes anemia, nerve pains in the hands and feet, muscle twitching or even fits especially in malnourished persons. These side effects can usually be treated by giving 50 mg of pyridoxine(vitamin B6) daily by mouth.
Sometimes, isoniazid can damage the liver. Persons who develop the signs of hepatitis (yellow color of skin and eyes, itching, loss of appetite, pain in the belly) while taking isoniazid should stop taking the medicine.
DOSAGES FOR ISONIAZID MEDICINE
For isoniazid (5 to 10 mg/kg/day) using tablets of 100 mg. Give isoniazid once a day
- Adults : 300 mg (3 tablets)
- Children : 50 mg (½ tablet) for each 5kg(child’s weigh)
For children with sever tuberculosis or persons with tubercular meningitis, double the above dose until improvement takes place.
For prevention of tuberculosis in family members of persons with TB, it is often recommended to give the above dose of isoniazid for 6 to 9 months.
RIFAMPIN (rifampicin, rifamycin)
This medicine often comes in tablets or capsule of 150 or 300 mg. This antibiotic is expensive but is powerful in fighting tuberculosis. It can shorten the treatment time by several months when combined with isoniazid and at least one other TB medicine.
Rifampin is also used to treat leprosy. It is important to keep taking rifampin regularly without interruption. Make sure that you get more before your supply runs out.
RISKS AND PRECAUTIONS
Rifampin can cause serious damage to the liver. A person who has liver problems or is pregnant should take this medicine under serious medical supervision.
Urine, tears, feces(poo), saliva, mucus from coughing (sputum) and sweat are colored red-orange by rifampin. Rarely, rifampin can cause fever, loss or increase of appetite, vomiting, nausea, confusion, skin rash and menstrual problems.
Rifampin reduces the effectiveness of oral contraceptives. So women taking birth control pills should get medical advice about increasing the dose or use another method such as condoms, IUD or a diaphragm while taking this medicine.
DOSAGE OF RIFAMPIN FOR TUBERCULOSIS
Dosage (10 mg/kg/day) tablets or capsules of 150 mg or 300 mg. Give rifampin once a day either 1 hour before or 2 hours after eating. In each dose, give :
- Adults : 600 mg (two 300 mg tablets or four 150 mg tablets)
- Children between 8 to 12 years old : 450 mg
- Children between 3 to 7 years old : 300 mg
- Children under 3 years old : 150 mg
This medicine often comes in tablets of 500 mg.
RISKS ANS PRECAUTIONS
Pregnant women should not take pyrazinamide
This medicine may cause painful joints, loss of appetite, nausea, vomiting, painful urination, fatigue and fever.
DOSAGE FOR PYRAZINAMIDE
(20 to 30 mg/kg/day) using tablets of 500 mg. Give daily for 2 months together with other TB medicines. In each dose give :
- Adults : 1500 or 2000 mg . (3 or 4 tablets)
- Children between 8 to 12 years : 1000 mg (2 tablets)
- Children between 3 to 7 years : 500 mg (1 tablet)
- Children under 3 years old : 250 mg (½ tablet)
This is also known as Myambutol, it often comes in tablets of 100 or 400 mg.
RISKS AND PRECAUTIONS
Ethambutol may cause eye pain or damage if taken in large doses for a long time. The medicine should be stopped if eye problems develop. Eye damage caused by ethambutol usually gets better slowly after the medicine is stopped.
DOSAGE OF ETHAMBUTOL
(25 mg/kg/day for the first two months, then 15 mg/kg/day) : 100 mg tablets or 400 mg tablets. Give once a day. For the first two months in each dose give :
- Adults : 1200 mg (three 400 mg tablets or twelve 100 mg tablets)
- Children : Give 15 mg for each kg the child weighs. But for tubercular meningitis, give 25 mg for each kg the child weighs.
After the first two months, give :
- Adults : 800 mg (two 400 mg tablets or eight 100 mg tablets)
- Children : Give 15 mg for each kg the child weighs.
Streptomycin is still a very useful medicine for treating tuberculosis. It is somewhat less effective but much cheaper than rifampin. This medicine often comes in : vials for injection with 500 mg in each ml.
RISKS AND PRECAUTIONS
Great care must be taken not to give more than the correct dose. Too much streptomycin for too long may cause deafness. If ringing of the ears or deafness begins, stop taking the medicine and see a health worker. Giddiness may occur when streptomycin is being given together with thiacetazone. Discontinue therapy and find an alternative to thiacetazone if possible.
DOSAGE FOR STREPTOMYCIN
15 mg/kg/day : vials of liquid ; or powder for mixing with water to give 1 gm of streptomycin in 2 ml.
FOR TREATMENT OF TUBERCULOSIS
Very severe cases, give 1 injection 2 or 3 times a week for two months; with each injection give :
- Adults : 1 gm or 2 ml
- Adults over 50 years old : 500 mg (1 ml)
- Children between 8 to 12 years old : 750 mg one and half ml
- Children between 3 to 7 years old : 500 mg (1 ml)
- Children under 3 years old : 250 mg (½ ml)
- Newborn babies : Give 20 mg for each kg of body weight ; thus a 3kg baby gets 60 mg (1/8 ml)
USE OF STREPTOMYCIN FOR OTHER TB
In emergencies, streptomycin and penicillin together can be used to treat certain severe infections. However, the use of streptomycin for infections other than tuberculosis should be very limited because frequent use of streptomycin for other illnesses makes tuberculosis resistant to it and also harder to treat. Streptomycin is sometimes used to treat gonorrhea that is resistant to penicillin.
THIACETAZONE COMBINED WITH ISONIAZID
This medicine comes in tablets combined with isoniazid (INH) in two sizes :
Large : INH 300 mg/ thiacetazone 150 mg
Small : INH 100 mg/ thiacetazone 50 mg
In sensitive cases or where the dose is even a little over the recommended dosage by weight, may cause a rash like measles and sore lips. If treatment is not stopped at once, it may go on to cause severe rashes all over with soreness of the mouth and eyes and even death. Weigh all the patients at the start of treatment; particularly those who may also have the AIDS virus.
DOSAGE FOR THIACETAZONE
2.5 mg/kg/day . Give once a day and in each of the dose, give :
- Adults if over 40 kg : 3 small tablets or one large tablet(300 mg/150 mg)
- Small adults, young people,20 to 40 kg : 2 small tablets (200 mg/100 mg)
- Children between 5 to 12 years old; 10 to 20 kg : 1 small tablet (100 mg/50 mg)
- Little children under 10 kg : ½ small tablet(50 mg/25 mg)