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TREATMENT AND ITS COST

TB is curable only if it is diagnosed quickly and treated appropriately with medication.
Treatment of tuberculosis involves:

  1. 1st line regimen- Drugs like Streptomycin, Isoniazid , Rifampicin, Ethambutol, Pyrazinamide.
  2. 2nd line regimen- Drugs like Kanamycin, Ethionamide, p-aminosalicylic acid, Ofloxacin, Cycloserine, Capreomycin, Thiacetazone.

Standard 9 Month regimen:
Combination of Isoniazid (5 mg/kg) and Rifampicin (10 mg/kg) daily on empty stomach is highly effective for all forms of drug sensitive tuberculosis. Addition of Pyrazinamide (25-35 mg/kg) plus either Streptomycin (1g) or Ethambutol (15or 25 mg/kg) is advised if sensitivity results are pending.

6 Month regimen:
This consists of 2 months of Isoniazid, Rifampicin, Pyrazinamide plus either Ethambutol at 25mg/kg or Streptomycin if Isoniazid resistance is suspected followed by Isoniazid and Rifampicin daily or 2 times a week for 4 months.

Combination tablets:
Several commercial preparations are available which have the drugs in one tablet to make it convenient for the patient to take his medicines.

Side Effects:
First line drugs have various side effects like hepatotoxicity, peripheral neuropathy, hypersensitivity reaction, nausea, vomiting, visual field constriction and renal problems.

Second line drugs have side effects like gastrointestinal intolerance, peripheral neuropathy, vertigo and hypersensitivity.

For these reasons patients treated for TB have to be regularly monitored for reaction to the drugs.

Cost of the treatment

Standard 6 month regimen will cost about Rs. 2300 (Approx. Rs 1500 for initial 2 months and approx. Rs. 800 for next 4 months)
Commercially available kits cost approx. Rs. 700 for 2 months and Rs. 1600 for 4 months.

The Second line regimen is very expensive and has various side effects.

Home Treatment

Home treatment for tuberculosis focuses on taking the prescribed medications correctly to reduce the risk of developing multidrug-resistant TB. Keep all your appointments, take your medications as prescribed, and report any side effects of the medications, especially vision problems. If you plan to move during the time that you are being treated, let your health professional know so that arrangements can be made for you to continue the treatment.

Home treatment includes:

Eating a balanced diet to provide your body with the nutrients that you need to fight the infection. If you need help, ask to talk with a registered dietitian.

Covering your mouth when you sneeze or cough. Until you have been on antibiotics for about 2 weeks, you can easily spread the disease to others. After coughing, dispose of the soiled tissue in a covered container. Talk with your health professional about other precautions you can take to prevent the spread of TB.
Sputum test, best way to detect TB of the lungs

Sputum test is the best way to detect tuberculosis of the lungs, according to Rajeshwari Ramachandran, former deputy director, senior grade, Tuberculosis Research Centre, Chennai.

“Sputum test is simpler and cheaper than X-ray. But for some strange reason, it does not have the same status,” she said, speaking at a seminar on tuberculosis organised here on Sunday by the Chest Foundation of India to mark the World Tuberculosis Day, which falls on March 24.

Concurring with Dr. Rajeshwari, Ram Gopalakrishnan, senior consultant physician, infectious disease and tropical medicine, Apollo Hospitals, speaking at the evening session, said the sputum test was under-utilised by physicians. “It should be the first test that should be done.” Relying on other methods to detect tuberculosis of the lungs often led to misdiagnosis and over-treatment or under-treatment.

Tuberculosis of the lungs is the most common form of the disease, Dr. Rajeshwari said. “Ninety per cent of the patients have TB of the lungs.” Half the number of such patients could infect others; whenever they coughed, sneezed, talked or spat, they let out tuberculosis germs into the air. A healthy person needed to just inhale a small number of these germs to get infected. Those who spread the disease were termed ‘sputum positive.’

A single patient could affect 10 or more people in a year. Hence, treating ‘sputum positive’ patients was the key to arresting the spread, Dr. Rajeshwari said.

Government hospitals followed regular procedures to prevent the spread of the disease, she said. This was done by prioritising sputum-positive patients for diagnosis and treatment. But private medical establishments did not adopt these procedures.

Raj B. Singh, chief respiratory physician, the Chest Centre, said there was no regulatory mechanism to ensure that private practitioners followed guidelines, such as performing the sputum test for suspected TB of the lungs.

Apart from educating private practitioners, there could be a regulation to refer all TB patients to a government hospital. But this would be effective only if the public health infrastructure had adequate capacity, which it did not currently have, Dr. Gopalakrishnan said.

Private practitioners needed to be roped in to control the spread of tuberculosis, said Nalini Krishnan, director-projects, Resource Group for Education and Advocacy for Community Health. The community had to get involved too, as tuberculosis did not affect a single patient but the whole community.

Source:
http://www.hindu.com/2009/03/16/stories/2009031660550900.htm



 
 
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