Treatment of tuberculosis

How is tuberculosis treated?

Also the treatment of the tuberculosis represents because of the special properties of the bacteria (slow growth, relative insensitivity to damaging influences from the environment, high mutation rates (changes in the genetic make-up)) pose a challenge.
There is now a treatment that has proven to be very effective, but requires a high level of willingness on the part of the patient.

Note: therapy

Basically, every tuberculosis must be treated!

Patients with a open tuberculosisi.e. they excrete large numbers of bacteria, must be isolated and, if possible, treated as an inpatient to prevent the bacteria from spreading.

As general measures of the Tuberculosis treatment one tries to treat comorbidities, symptomatic medication (for example Cough Syrup) and to induce the patient to strictly abstinence from alcohol and nicotine.

The current one drug treatment of tuberculosis consists of a two-month gift of one Combination of four of special Antibiotics, so-called antituberculotics, followed by another four months with a Combination of two. With these multiple combinations, one tries to kill also simply mutated bacteria.

The four standard drugs of tuberculosis treatment are:

  • INH is a drug that inhibits the assembly of the special cell wall of the bacteria and therefore has a very specific effect only against mycobacteria. It is activated by the bacteria 's enzymes and therefore has comparatively few side effects. However, it does not reach any pathogens that are in human immune cells.
  • Rifampicin is a drug that prevents new ones in the bacterial cell Proteins (Egg whites) getting produced. It also works against the pathogens that are in the body's own defense cells.
  • Pyrazinamide only works against multiplying mycobacteria, which is why it can only be used sensibly in the initial phase of the disease. It works by being similar to INH interferes with the assembly of the cell wall. As a significant side effect, this drug can damage the liver.
  • Ethambutol is also an anti-tuberculosis drug that disrupts the assembly of the cell wall. However, it has a different point of attack than INH or pyrazinamide and thus has a useful complementary effect.

INH and Rifampicin are given in the second phase as a combination of two for four months.

There is one vaccination with mycobacteria, the effectiveness of which is, however, controversial and which is currently not supported by the StIKo (Standing Committee on Vaccination) is recommended. It is vaccinated with mycobacteria of the BCG strain, the risk of infection for humans is weakened.
After vaccination, there is a temporary increase in bacteria that are injected under the skin. Later there is scarring at the injection site. The protective effect is limited in time, however, after several years the effect diminishes significantly. The tuberculin test also now produces a positive result because the patient had contact with mycobacteria. In very rare cases, vaccination can be the cause of tuberculosis if the patient's immune system is insufficient.

A problem for medicine is the worldwide increasing number of bacteria resistant (= insensitive) to the usual drugs. These are bacteria which, through improper treatment, had the chance of becoming resistant to the drugs. In Germany this affects approx. 2% of bacteria. Much higher rates can be found in some of the former Eastern Bloc countries. Up to 60% can be affected there.