New Cases
According to the Centers for Disease Control and Prevention, about 13,000 new cases of active tuberculosis were diagnosed in 2008. While this makes the disease fairly rare, the number of people who require treatment is actually much higher. This is because the disease itself often doesn't develop for months or years following exposure, and treatment before active infection occurs can prevent the illness from developing.
Diagnosis
Tuberculosis diagnosis begins with an antibody (PPD) test, which is often performed routinely in areas where tuberculosis is more common. Should the test give a positive result, a chest X-ray and physical examination are performed to determine whether the patient has active tuberculosis or not. Sputum and blood tests may also be used to confirm the diagnosis. Depending on the results, treatment for either tuberculosis exposure or infection is started.
Preventative Tuberculosis Treatment
When a patient has a positive PPD test and a negative chest X-ray, isoniazid (INH) is the most commonly used treatment. Isoniazid is an antibiotic tablet that is usually taken daily 9 months, but may also be taken in larger doses two or three times a week for 9 months. Because isoniazid can cause vitamin B6 (pyridoxine) deficiency, most doctors recommend vitamin supplementation for the duration of therapy.
Alternately, tuberculosis exposure can be treated with the antibiotic rifampin, either alone or in combination with isoniazid or pyrazinamide. These treatment regimens have the advantage of requiring only 2 to 4 months of medication. More aggressive treatment, such as adding additional antibiotics, is used for patients who are HIV positive or have other significant medical risks.
Active Tuberculosis Treatment
If test results indicate that the patient has an active tuberculosis infection, a combination of antibiotics is started immediately. The first stage of treatment, which lasts for 2 months, consists of treatment with isoniazid, rifampin and ethambutol. Another antibiotic, pyrazinamide, may be added to this regimen. All of these drugs are given as tablets, and hospitalization is not required unless the patient is very ill.
During the first few weeks of treatment, the patient is usually asked to stay at home to avoid infecting others. However, there is no need for complete isolation because household members have almost certainly already been exposed to the disease. Anyone who lives with or is in frequent contact with the patient must be tested for tuberculosis and receive treatment if appropriate.
Once the first 2 months of antibiotic therapy have passed, ethambutol and pyrazinamide are no longer required. The patient must then take isoniazid and either rifampin or rifapentine (a related drug) for at least 4 months. Unless tests indicate otherwise, the patient is considered cured. However, successful treatment does not prevent reinfection so regular screening tests should still be performed.
Throughout the treatment process for tuberculosis, the patient should periodically receive tests to verify that the medication is working properly. In some cases, tuberculosis is resistant to the antibiotics typically used and a different combination of medications is required. Occasionally, the disease isn't antibiotic-resistant but takes longer than usual to cure, so medication is simply continued for an additional 2 months.
Tags: active tuberculosis, chest X-ray, patient active, patient active tuberculosis, patient must, tuberculosis exposure