Management of tuberculosis

Management of Tuberculosis

Diagram of tuberculosis drugs and their actions

The management of tuberculosis (TB) involves a combination of medical treatment, public health strategies, and supportive care. The primary goal is to cure the patient, prevent transmission, and reduce the incidence of drug-resistant TB.

Medical Treatment

The cornerstone of TB management is the use of anti-tubercular drugs. The standard treatment regimen for drug-susceptible TB involves a combination of four first-line drugs:

• Isoniazid
• Rifampicin
• Pyrazinamide
• Ethambutol

First-line Drugs

Structure of Isoniazid

• Isoniazid: A bactericidal agent that inhibits the synthesis of mycolic acids, essential components of the mycobacterial cell wall.

Structure of Rifampicin

• Rifampicin: A bactericidal antibiotic that inhibits bacterial RNA synthesis by binding to the beta subunit of DNA-dependent RNA polymerase.

Structure of Pyrazinamide

• Pyrazinamide: A prodrug that is converted to the active form, pyrazinoic acid, in acidic conditions, disrupting mycobacterial cell membrane metabolism and transport functions.

Structure of Ethambutol

• Ethambutol: Inhibits arabinosyl transferases involved in the polymerization of arabinogalactan, an essential component of the mycobacterial cell wall.

Second-line Drugs

In cases of drug-resistant TB, second-line drugs are used. These include:

• Streptomycin
• Ciprofloxacin
• Moxifloxacin
• P-Aminosalicylic acid

Structure of Streptomycin

• Streptomycin: An aminoglycoside antibiotic that inhibits protein synthesis by binding to the 30S ribosomal subunit.

Structure of Ciprofloxacin

• Ciprofloxacin: A fluoroquinolone that inhibits bacterial DNA gyrase and topoisomerase IV, essential for DNA replication.

Structure of Moxifloxacin

• Moxifloxacin: Another fluoroquinolone with a similar mechanism of action to ciprofloxacin, used in multidrug-resistant TB.

Structure of P-Aminosalicylic acid

• P-Aminosalicylic acid: An antimetabolite that inhibits folic acid synthesis, interfering with mycobacterial growth.

Treatment Regimens

The standard treatment for drug-susceptible TB is a 6-month regimen:

• Intensive phase: 2 months of isoniazid, rifampicin, pyrazinamide, and ethambutol.
• Continuation phase: 4 months of isoniazid and rifampicin.

For multidrug-resistant TB (MDR-TB), treatment is more complex and prolonged, often lasting 18-24 months, and involves second-line drugs.

Monitoring and Support

Chest X-ray of a patient with tuberculosis

Monitoring of treatment involves regular follow-up visits, sputum smear microscopy, and culture to assess response to therapy. Adherence to treatment is crucial to prevent relapse and the development of drug resistance. Directly Observed Therapy (DOT) is recommended to ensure compliance.

Public Health Strategies

Public health measures include contact tracing, vaccination with the BCG vaccine, and health education to reduce transmission. Screening and preventive therapy for latent TB infection are also important components of TB control programs.

Related Pages

• Tuberculosis
• Multidrug-resistant tuberculosis
• Directly observed therapy
• BCG vaccine