Tuberculosis - I.T. Pyatnochka 2005

Treatment of Tuberculosis
Pathogenetic Treatment of Tuberculosis

It aims to achieve the following objectives:

1. reducing exudative and pneumonic manifestations in the lesion, accelerating its resolution and healing with minimal residual changes;

2. correction of metabolic processes and dysfunctions of various Organs and systems impaired by tuberculosis intoxication and antimycobacterial drugs;

3. enhancement of mild inflammatory reactions and stimulation of reparative processes.

To accomplish these objectives, the following Methods of rational therapy are applied:

I. General Pathogenetic Therapy agents, including:

1. hygienic and dietary regimen, which ranges from strict bed rest to a gentle, training regimen, and finally to a work adaptation regimen.

2. Rational, high-calorie, and vitamin-enriched Nutrition (Pevzner's diet No. 11).

3. Physical methods and therapeutic exercise: aero-, helio-, hydrotherapy, and climatotherapy.

4. Psychotherapy and autogenic training.

5. Agents for detoxification and correction of METABOLISM, in particular protein and Water-electrolyte balance, redox processes, acid-base balance, as well as The regulation of hemodynamics and diuresis.

To achieve these goals, the following are used:

a) anabolic agents: Insulin 4–5 IU intramuscularly in the morning; anabolic steroid preparations (methandrostenolone or dianabol 0.005 g 1–2 times a day orally before meals, 2.5% oil solution; phenobolin or durabolin, nerobolil 1.0 ml intramuscularly once a week, retabolil 5% oil solution 1.0 ml once every 2 weeks, methyltestosterone 0.005 g sublingually 1–3 times a day);

b) Energy Metabolism stimulants (cocarboxylase hydrochloride 0.05 g intramuscularly once a day, ATP 1.0 ml intramuscularly once a day, Lipoic Acid 0.025–0.05 g orally 2–3 times a day);

c) multivitamins, especially Vitamin C 0.1 g orally 3 times a day, B-complex Vitamins — pentavit 3 tablets orally 3 times a day, vitamax or vitamax plus 1 capsule orally once a day, multi-tabs 1 tablet orally after meals once a day, unicap 1 tablet orally after meals once a day;

d) antioxidants (tocopherol acetate 1 capsule (0.05–0.1 g) orally 1–2 times a day, sodium thiosulfate 30% solution 5.0 ml intravenously once a day, galascorbin 0.5 g orally 3 times a day);

e) antihypoxants (sodium oxybutyrate 0.75 g orally 2–3 times a day);

f) agents with combined and immunotropic action (riboxin 0.2–0.4 g orally before meals 3 times a day);

g) electrolyte solutions (neohemodes, rheosorbilact, neocompensan, gluconeodes, Ringer-Locke solution, rheopolyglucukin 200–400 ml intravenous drip once a day), panangin 1–2 dragees orally 3 times a day, calcium pangamate 0.05–0.1 g orally 3 times a day); in case of severe acidosis, 4% sodium bicarbonate solution 100–200 ml;

h) Blood transfusions, plasma 200 ml intravenous drip once a week; albumin, protein 100–200 ml intravenous drip 1–2 times a week;

i) agents for the correction of impaired Functions of Internal Organs and systems.

II. Immunocorrective therapy. It is carried out after evaluating the function of the T-lymphocyte system (cellular Immunity), B-lymphocyte system (humoral immunity), and nonspecific defense factors. Among immunomodulators, the following are used: thymalin 0.005–0.01 g intramuscularly daily, tactivin 0.01% solution (at a dose of 1–2 mcg/kg of body weight) subcutaneously at night for 10 days, sodium nucleinate 0.5 g orally after meals 3–4 times a day, splenin 2.0 ml intramuscularly daily for three weeks, then 1.0 ml every other day for 2 months, levamisole or decaris 0.15 g orally once a day for three consecutive days, then once a week for 3 consecutive weeks, interferon 5 drops in each nasal passage 1–2 times a day, prodigiosan 0.005% solution 0.5 ml intramuscularly once every 5–7 days, for a course of 3–6 injections, ethimizol 0.1 g orally after meals 3 times a day, histaglobulin starting with 1.0 ml intramuscularly, then 2.0–3.0 ml with a 3-day interval, for a course of 5–10 injections.

Among non-pharmacological Treatment methods used for immunocorrection and as anti-inflammatory approaches are enterosorption, hemosorption, speleotherapy, magnetotherapy, laser therapy, etc.

Immunocorrective therapy should be performed after the patient's intoxication has been eliminated.

III. Nonspecific anti-inflammatory drugs that reduce excessive exudative-pneumonic reactions. These include:

1) corticosteroids: cortisone, hydrocortisone suspension 2% 1.0 ml combined with Antimycobacterial agents for inhalation in laryngeal and bronchial tuberculosis, prednisolone (starting with 0.02-0.04 g daily orally, divided into 4-5 doses, then tapering the dose to 0.005-0.01 g daily), dexamethasone 0.002-0.003 g daily, triamcinolone 0.004-0.016 g daily orally in 3-4 divided doses. Course duration: 1-1.5 months.

2) non-hormonal anti-inflammatory drugs: pyrazolone derivatives (butadion 0.15 g orally after meals 3 times a day, pyrabutol 1 dragee orally after meals 3 times a day, brufen 0.2 g orally after meals 3 times a day; phenothiazine derivatives (aminazine 0.025 g orally 2-3 times a day); quinoline derivatives (chloroquine, delagil 0.25 g orally after meals once a day), antihistamines (diphenhydramine 0.05 g orally 1-3 times a day, phencarol 0.025-0.05 g orally after meals 1-3 times a day, diprasin or pipolfen 0.025 g orally after meals 2-3 times a day, diazolin 0.01-0.02 g orally 2-3 times a day, suprastin 0.025 g orally with meals 2-3 times a day, tavegyl 0.001 g orally twice a day);

3) Proteolytic Enzymes (Trypsin, Chymotrypsin 0.005-0.01 g intramuscularly 1-2 times a day, or 0.005-0.01 g per 5 ml of isotonic sodium chloride solution or distilled water, for inhalation or endobronchial instillation);

4) proteolytic Enzyme Inhibitors (contrykal 10,000-20,000 IU, gordox 100,000-300,000 IU in 300-500 ml of physiological sodium chloride solution intravenously via drip once daily, EACA, amben);

5) dimexide exhibits a pronounced anti-inflammatory effect and is capable of transporting other drugs deep into Tissues; a 5-10% solution of 1.0-2.0 ml is used in combination with heparin, novocaine, antibacterial, and corticosteroid agents for inhalation, lavage of the purulent pleural cavity and tracheobronchial tree;

6) a group of biologically active agents possesses anti-inflammatory and antiallergic effects, specifically pyrogenal 25-50 MDP intramuscularly once every 3 days, gradually increasing the dose until body Temperature rises to 37.5-38 °C, but not exceeding 1,000 MPD of the drug, after which the dose is gradually tapered back to the starting amount; heparin 5-10 thousand IU twice a day intramuscularly;

7) etimizol (a stimulant of the pituitary-adrenal system and suppressor of inflammatory processes) 0.1 g orally after meals 3 times a day for one month;

8) physical therapy (Electrophoresis, intraorgan electrophoresis, inhalations);

9) herbal medicine using infusions and tinctures of medicinal plants with anti-inflammatory (horsetail, knotweed, celandine, St. John's wort, marigolds, onion, garlic, etc.) and adaptogenic (eleutherococcus, ginseng, and others) properties, administered orally and via inhalation;

10) psychotherapeutic techniques (autogenic training, psychotherapy, music therapy, hypnosis, and suggestion).

IV. Stimulants of reparative processes and cavity healing. These are typically prescribed after 3-4 months, In the second phase of antimycobacterial therapy. They include tuberculin, desoxycorticosterone acetate (DOCA) 0.0025-0.005 g sublingually once a day or every other day, somatotropin 4 IU intramuscularly 3 times a week for 1-3 months, ergocalciferol 4,000-5,000 IU orally 1-2 times a day, insulin up to 10 IU intramuscularly in the morning before meals once a day, biostimulants (vitreous body 1.0-2.0 ml subcutaneously daily, plasmol 1.0 ml subcutaneously daily or every other day, aloe extract 1.0 ml subcutaneously daily, FiBS 1.0 ml subcutaneously, placental suspension 2.0 ml subcutaneously once every 7-10 days, antireticular cytotoxic serum (ACS) 0.5-0.75 ml subcutaneously 2-3 times at intervals of 2-3 days, anabolic Hormones (nerobol, dianabol, retabolil, phenobolil), Blood and Its derivatives (plasma, albumin, protein).

Skilful application of pathogenetic therapy alongside antimycobacterial agents enhances treatment efficacy.

Sanation of the tracheobronchial tree holds one of the most prominent places in the comprehensive treatment of patients with respiratory tuberculosis. Sanation methods are divided into passive and active. The former include postural drainage and expectorant therapy, while the latter encompass all methods involving the aspiration of tracheobronchial contents and the direct administration of medications into the tree.

To facilitate sputum excretion, the following medications are used:

1) agents that stimulate expectoration through passive secretion by bronchial glands, reduction of sputum viscosity, and enhancement of ciliated epithelium activity and bronchiolar peristalsis:

а) reflex-acting agents: sodium benzoate 0.2-0.5 g orally 3-4 times a day, terpin hydrate 0.25-0.5 g orally three times a day, lanceleaf thermopsis herb powder 0.01-0.05 g orally three times a day, marsh mallow ROOT infusion (6.0:180.0) 1 tablespoon orally every three hours, licorice root infusion (6.0:180.0) 1 tablespoon orally every three hours, coltsfoot leaf infusion (5.0-10.0:200.0) 1 tablespoon 4-6 times a day, lycorine 0.0001 g orally 3 times a day;

б) resorption-acting (or direct-acting) agents: potassium iodide 1-3% solution 1 tablespoon orally 3-5 times a day, sodium iodide 0.3 g orally 3 times a day, ammonium chloride 0.2-0.5 g orally 3 times a day, anise-ammonia drops 10-15 drops orally 3 times a day, anise oil 3 drops orally 1-2 times a day, etc.;

2) mucolytic (secretolytic) agents that improve expectoration by thinning sputum and stimulating The production of endobronchial secretions:

а) proteolytic enzymes: trypsin, chymotrypsin, chymopsin, Ribonuclease, deoxyribonuclease 0.2% solution 3 ml for inhalation and endobronchial administration;

б) synthetic agents: acetylcysteine 20% solution 4 ml per inhalation 2-3 times a day or 10% solution for endobronchial administration; bromhexine 0.016 g orally 3 times a day.

In addition, abundant warm fluids (up to 1-1.5 liters per day) are recommended (milk with baking soda and honey, Borjomi mineral water, Luzhanska, etc.).

Active sanation methods include inhalations, endobronchial instillations of antimycobacterial drugs, and pathogenetic medications. They are frequently combined with glucocorticosteroids that stimulate regeneration (pentoxyl 0.3 g orally after meals 3 times a day; methyluracil 0.5 g orally with meals 3 times a day), and antifungal agents (nystatin or levorin sodium salt 500,000 IU orally 3 times a day, nizoral 1 tablet per day, fungizone, etc.). For tuberculous endobronchitis, inhalations of a mixture containing aminophylline 2.4% - 0.5 ml, diphenhydramine 1% - 0.5 ml, novocaine 0.5% - 0.5 ml, isoniazid 5% - 5 ml, rifampicin (0.15 g) - 1.0 ml, hydrocortisone hemisuccinate or prednisolone (0.0125-0.025 g) 0.5-1.0 ml are indicated, without discontinuing baseline antimycobacterial therapy. In cases of hemoptysis, hemostatic drugs are used (Thrombin 60-125 IU for inhalation, hemophobin 5.0 ml per inhalation).

Specific allergen immunotherapy (tuberculin therapy) for tuberculosis involves the therapeutic administration of tuberculin. It exerts a stimulating and desensitizing effect and is used in both pulmonary and Extrapulmonary tuberculosis.