Drug-resistant tuberculosis - prevention and treatment

(Baonghean) - Drug-resistant tuberculosis is a condition in which tuberculosis bacteria are resistant to anti-tuberculosis drugs. These cases are very difficult to treat and are a very dangerous source of infection for the community.

* Drug-resistant tuberculosis is classified as follows:

- Natural drug resistance: When the tuberculosis bacteria in the lesion grow to a certain number, some bacteria (due to mutations in the gene) become resistant to a type of anti-tuberculosis drug.

- Primary drug resistance: Drug resistance in patients who have never been treated with tuberculosis drugs, now have drug-resistant tuberculosis due to bacterial infection from a patient with drug-resistant tuberculosis.

- Acquired drug resistance: Is drug resistance in patients who have been treated for tuberculosis, but due to improper treatment, drug-resistant tuberculosis strains develop.

- Multi-drug resistant TB (MDR TB): Is drug resistance in patients with tuberculosis bacteria resistant to both INH and Rifampicin.

- Extensively drug-resistant TB (XDR TB): These are cases of multidrug-resistant tuberculosis that are resistant to any drug in the Quinolone group and resistant to at least one injectable second-line anti-tuberculosis drug (Amikacin, Capreomycin or Kanamycin).

* Clinical and paraclinical symptoms of drug-resistant tuberculosis:

Clinical: While being treated for tuberculosis, symptoms of fever, cough, and sputum do not subside or subside for a while and then reappear with increased symptoms.

Paraclinical: The image of the lesion on the chest X-ray film does not change or new lesions appear. Sputum test shows AFB continuously positive or negative for a period of time then positive again or alternating negative and positive.

Diagnosis of drug-resistant tuberculosis:

- Culture for tuberculosis bacteria, antibiotic susceptibility testing with first-line and second-line anti-tuberculosis drugs.

- Molecular biology method (sequencing): Can diagnose quickly by identifying drug-resistant gene segments.

Causes of drug-resistant tuberculosis

- Due to late detection: When the number of tuberculosis bacteria reproduces to a certain number, there will be some bacteria that mutate to be resistant to anti-tuberculosis drugs. For example, in a tuberculosis lesion in the lung, when the number of tuberculosis bacteria reaches 10 million, there will be 1 bacteria that is resistant to rifampicin, and 100,000 bacteria will have mutated bacteria that are resistant to Streptomycin and Isoniazid.

- Improper treatment of tuberculosis:

+ Do not combine tuberculosis treatment drugs (single treatment)

+ Insufficient dose of tuberculosis medicine

+ Using anti-tuberculosis drugs without following the regimen.

+ Not taking medicine regularly every day, not taking medicine at the right time.

+ Patients who stop treatment or do not complete the prescribed treatment period (current tuberculosis treatment regimen is 8 months).

Consequences of drug-resistant tuberculosis:

- Patients who do not get treatment will die.

- Continuing to infect the community with drug-resistant tuberculosis bacteria is very dangerous.

Treatment and prevention of drug-resistant tuberculosis:

Treatment of drug-resistant tuberculosis is currently very difficult, especially for patients with multidrug-resistant and extensively drug-resistant tuberculosis. Currently, Cao Bang province has no facility for treating drug-resistant tuberculosis. Drug-resistant patients are sent to K74 Hospital in Vinh Phuc province for examination and treatment management.

Drug-resistant tuberculosis requires continuous treatment for 18 to 20 months, using many types of combination drugs, which are very expensive and have many complications when using drugs. The problem of managing drug-resistant tuberculosis treatment is a difficult challenge for the anti-tuberculosis program because most tuberculosis patients are poor, in remote areas. Access and treatment of tuberculosis is difficult. Therefore, to prevent drug-resistant tuberculosis, there is no other way than: Early detection and timely treatment for tuberculosis patients. Strictly manage the treatment of tuberculosis patients to ensure that patients take medicine according to the correct regimen and treatment principles, which are:

- Combine anti-tuberculosis drugs and adhere to treatment in 2 phases, the attack phase lasts for the first 2 to 3 months, the maintenance phase lasts for the next 5 to 6 months to ensure the patient is cured.

- Take the medicine in the correct dosage, once a day, at a fixed time and take the medicine at least 1.5 hours apart from meals.

- Treatment duration according to the prescribed regimen is 8 months.

Thanh Tuong

(Synthetic)