Tuberculosis was once known as the "white plague". In 1882, Robert M. Robert Koch discovered that Mycobacterium tuberculosis is the causative agent of tuberculosis, laying the bacteriological foundation for tuberculosis control.
With the further study of the biological characteristics of Mycobacterium tuberculosis, effective anti-tuberculosis drugs such as streptomycin and isoniazid have emerged, especially after the advent of rifampicin in 1965, which has opened a milestone in short-course chemotherapy and effectively curbed tuberculosis. But in the late 1980s, with population movements, the emergence of HIV and an increase in drug-resistant TB cases, TB made a global comeback, and in 1993 the World Health Organization declared a global TB emergency. The prevalence of drug-resistant TB bacteria has received increasing attention in recent years.
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What is drug-resistant tuberculosis?
The anti-TB drugs used in patients with common pulmonary tuberculosis include rifampicin, isoniazid, ethambutol, and pyrazinamide, which are often referred to as first-line anti-TUBERCULO drugs. When the treatment compliance of ordinary tuberculosis patients is not good (often forget to take drugs or take drugs for a period of time and then stop for a period of time, or even self-medication reduction, etc.), the treatment plan is unreasonable (the type of drugs is insufficient or the amount of drugs taken is not enough), the digestive system is malabsorption and other reasons, resulting in the body mycobacterium tuberculosis becomes more severe, can not be killed by one or more anti-tuberculosis drugs (that is, anti-tuberculosis drugs are resistant), become resistant tuberculosis patients; Some patients develop primary drug-resistant tuberculosis as a result of infection with drug-resistant tuberculosis patients who have contracted drug-resistant tuberculosis.
What is commonly referred to as drug-resistant tuberculosis refers to the most core anti-tuberculosis drug rifampicin-resistant tuberculosis, also known as rifampicin-resistant tuberculosis. If TB bacteria tolerate more drugs, the more difficult treatment becomes.
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Dangers of drug-resistant tuberculosis
Compared with ordinary tuberculosis, drug-resistant tuberculosis has the characteristics of severe disease, difficulty in cure, long treatment time, taking more drugs, large chance of adverse reactions, high treatment costs (dozens of times that of ordinary tuberculosis), and the most serious is the occurrence of extensive drug resistance, almost no drug treatment. In addition, due to the long course of drug-resistant tuberculosis, there are more opportunities to transmit it to others, and once the infected person becomes ill, it is drug-resistant tuberculosis, which is more harmful to society.
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How is drug-resistant tuberculosis diagnosed?
In the diagnosis of drug-resistant tuberculosis, in addition to conventional sputum smears, sputum cultures, rapid molecular diagnosis, and chest imaging, it is also necessary to diagnose whether the infected Mycobacterium tuberculosis is resistant to one or more anti-tuberculosis drugs through traditional drug sensitivity tests or rapid molecular biology detection techniques, and if there is resistance, it proves that the drug treatment is ineffective. Since symptoms alone cannot diagnose drug resistance and need to rely on laboratory diagnosis, as long as there are suspicious symptoms of tuberculosis such as coughing up sputum, fever, hemoptysis or blood in sputum, they should be diagnosed and treated in a designated hospital in time. If in the process of using first-line anti-tuberculosis drugs, sputum bacteria continue to turn, the clinical manifestations do not improve, or even the symptoms worsen, or the symptoms of tuberculosis reappear after the prescribed treatment course has been completed, it is necessary to consider whether there will be drug-resistant tuberculosis bacteria, and timely go to the tuberculosis designated hospital for drug sensitivity testing.
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How is drug-resistant tuberculosis treated?
Drug-resistant tuberculosis treatment is more complex than ordinary tuberculosis, treatment often requires a variety of anti-tuberculosis drugs combined, the whole process of treatment takes 18 to 20 months, but in order to effectively isolate the source of infection, reduce the spread of drug-resistant bacteria to others, as well as the doctor's adjustment of the treatment plan and the effective treatment of adverse reactions of patients, generally drug-resistant patients will be hospitalized for 2 months, and continue to complete the treatment course under the supervision of community doctors after discharge.
Once an adverse reaction occurs during treatment, it should be treated in a tuberculosis designated hospital in time. Of course, there are also short-course oral regimens of 9 to 11 months, but this is only for patients with mild symptoms, less extensive lung lesions, and sensitivity to or previous use of drugs for no more than 1 month.
No matter what kind of treatment plan, if the patient does not follow the doctor's medical advice, not only can not be effectively treated, but also may be infected to more healthy people, especially the closest relatives around.
Since the success rate of treatment of drug-resistant tuberculosis patients is lower than that of ordinary tuberculosis patients, once the second-line anti-tuberculosis drugs are used for treatment, if the opportunity for treatment is not cherished, the treatment is stopped, and it is very likely to develop into widely drug-resistant tuberculosis, and the result is likely to be no drug to save.
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Why insist on taking the whole drug?
Anti-TUBERCULO therapy is divided into two stages: intensive treatment and consolidation phase treatment. Because some of the mycobacterium tuberculosis in the human body are active and grow rapidly, some are dormant and grow slowly. Through the intensive period of treatment, most of the active bacteria will be eliminated, the patient's symptoms will also be significantly improved, some patients are prone to paralysis, thinking that they are cured to stop the drug, do not know that those dormant bacteria are still alive in the body, so you must insist on taking the drug until the end of the course of treatment, in order to completely kill all mycobacterium tuberculosis.
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Will alcohol consumption and smoking have any effect on drug-resistant tuberculosis treatment?
Alcohol consumption and smoking can have an impact on drug-resistant tuberculosis treatment!
Effects of alcohol consumption on the treatment of drug-resistant tuberculosis:
The patient's liver is already under enormous pressure from anti-TB drugs, and drinking alcohol further increases their burden;
Alcohol can affect the efficacy of the drug, leading to more adverse reactions;
Drinking too much alcohol may cause you to forget to take your medication.
Effects of smoking on drug-resistant tuberculosis treatment:
Smoking can lead to other lung diseases, which can increase the burden on the lungs on the basis of tuberculosis, resulting in coughing up sputum more severely;
Smoking makes people weaker and more vulnerable to other diseases.
In summary, although the treatment of drug-resistant tuberculosis is difficult, the treatment of drug-resistant tuberculosis, like the treatment of ordinary tuberculosis, has been verified by global clinical trials to be effective, as long as you adhere to the doctor's instructions, there will be a great chance of successful treatment.
Review: Lei Shiguang, Li Jinlan, Chen Huijuan
Contributed by: He Yuying
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