Why treating tuberculosis fail?

Assoc. Hoang Long Phat

In 1882 the German scientist R.Koch invented the bacillus that causes tuberculosis, from which the bacterium was named after him: BK. Until the middle of the 20th century, effective TB medicines came into being (streptomycin, IMT or isoniazid, PAS .). TB was not scary, it could be cured.

But by the early 70-80s, many people with severe TB and long-term illnesses appeared in the last century and eventually died of tuberculosis. Later, in the late 70s and 80s, the scientists discovered many other powerful effective TB drugs that not only killed TB bacteria but also "sterilized" (eradicating the root) such as rifamficin (R, RMP). , parazinamide (Z, PZA) and inhibitors of tuberculosis growth like ethambutol (E, EMB .). Many severe tuberculosis are cured.

R. Koch Doctor (Photo: Cache.eb.com)

But history repeats. On March 24, 1992, the 100th anniversary of R.Koch's discovery of tuberculosis tuberculosis against the World Tuberculosis Association (CLCG) complained: tuberculosis not only was not controlled but on the contrary, there was a risk of explosion. again! The current reality has proved that TB has developed and increased in every country in the world. 'TB is in one place, it will be everywhere' (WHO March 24, 2007). Tuberculosis is associated with immunodeficiency diseases such as HIV / AIDS, diabetes, viral diseases . so why does TB cure fail?

Causes of illness

Understanding of tuberculosis: At present, people understand that TB is very limited, so too disrespectful, thinking that " coughing wind ", "coughing tobacco, tobacco" will not go to medical examination, until the occurrence of variables such as coughing up blood, pneumothorax, can be depleted, respiratory failure . new to the examination, at that time the disease was late, the lungs were chiseled with lots of cavities . very difficult to cure, finally death, if any positive treatment may be saved, but left many sequelaes: difficulty breathing, heart failure . no labor becomes a burden for families and society. Also due to poor understanding should not keep hygiene prevention for the community, cough spitting indiscriminately is the source of spreading TB bacteria to everyone around.

Do not abide by the treatment regimen

- Taking drugs irregularly, seeing good health, gaining weight, eating well, thinking that they will not be examined and checked at medical facilities are monitoring and treating for themselves.

- Or see in the newspapers and television that the cure for tuberculosis is only 6 months and 8 months. Considering that there is no need to cure it. In fact, each person with tuberculosis is not the same, in different types of patients, some people only have tuberculosis, other methods and duration of treatment for those who have tuberculosis and suffer from extrapulmonary TB such as meningitis, Peritoneal, osteoarthritis . especially for meningeal tuberculosis only treat 6-8 months without monitoring health check before deciding to stop the drug, this risk is very bad. Even in cases where people only have tuberculosis, but the lungs have caves, sputum stained directly with BK (+) one (+), (++), (+++) are also different from those of pulmonary workers not yet available. cave, direct expectorant BK (-). The 6-8 month tuberculosis treatment period recommended by the World Health Organization (WHO) is the minimum time to treat tuberculosis, when stopping or prolonging the treatment period or not needing teachers Special medicine decisions, or when having difficulties need to be consulted and medical line specialized in superior pulmonary tuberculosis.

The patients see books and articles disseminating knowledge and then self-treat, or ask a medical officer who has not been trained in tuberculosis treatment. But TB treatment is not simple, requires a deep understanding of the mechanism of the use of antibiotics, tuberculosis and tuberculosis . can apply the appropriate regimen of TB treatment, not to mention the TB drugs still cause There are many side effects, or fatal complications, such as tuberculosis-induced hepatitis, according to the world literature, the rate of tuberculosis-induced hepatitis is 3%, in our country the rate is up to 7-8%.

TB has been discovered, but not yet cured immediately, still worrying that agencies and families are busy . need to be solved before rest assured to cure! During that time, Koch bacteria did not wait for me to finish work before I developed? !!!

Causes by physicians

Diagnosis of tuberculosis is actually not simple, it is easy to confuse with many other lung diseases, sometimes the lungs have obvious lesions but sputum can be stained directly negative, mistaking for pneumonia, chronic bronchitis , lung abscess, or lung cancer. Therefore, it is necessary to monitor sputum test after 1 month + 2 months, if due to pulmonary tuberculosis sooner or later, it will be found in sputum for direct staining, but this patient and even some physicians have ignored . When the disease is severe, the lungs are destroyed, treatment will be difficult, easy to fail.

Improper treatment of the method: Treatment of tuberculosis requires the combination of at least 3 tuberculosis drugs that are still effective against tuberculosis, although nowadays WHO has reissued the treatment regimen, but not applied mechanically. but need a consultation with the higher level and the TB medical specialists must always update their knowledge to keep up with medical progress. In addition, in fact, it is not uncommon for some ' gardeners ' to pretend that physicians 'carry the stethoscope' to treat tuberculosis without getting worse and the patients die of other lung diseases without TB like K lung. .

Tuberculosis treatment does not monitor or control patients who take drugs or not (DOTS). In 1957, right after the establishment of the Central Institute of Tuberculosis Prevention, the Minister of Health Pham Ngoc Thach emphasized the role of controlling drug use of patients. In the last decades of the 20th century, there were many effective TB chemotherapy drugs, but WHO recommended the National TB Program in all countries in the world to control whether patients take medicine (DOTS). If taking irregular drugs, how can antibiotics have enough to kill TB bacteria?

Causes due to severe tuberculosis

Extensive pulmonary injury, much destruction of cavity formation contains many tuberculosis bacteria, there are many strains of BK resistant to drugs, making TB treatment ineffective. In the pulmonary tuberculosis, chronic fibrosis tuberculosis (4b) is still cured and still faces many difficulties, the wider the area of ​​tuberculosis lesions, the worse the prognosis is, the more likely it is to fail treatment, the risk of many complications such as coughing up blood, pneumothorax, possible exhaustion, respiratory failure . eventually leading to death.

In addition, there are a number of favorable factors to reduce the body's resistance (immunodeficiency), which can make more serious TB such as pregnancy, breastfeeding, alcoholism, diabetes, poor diet. Natural disasters and wars, especially today, viral diseases and HIV / AIDS have developed a lot, making tuberculosis more and more increasing, making it easier to cause tuberculosis to break out into tuberculosis.

Summary of the above causes leading to failed TB treatment: severe pulmonary tuberculosis, wide lesions, multiple sputum BK; drug-resistant tuberculosis bacteria; poor prevention of diseases due to lack of knowledge about tuberculosis, spitting indiscriminately, spreading drug-resistant tuberculosis bacteria to people around the affected person who also have drug-resistant TB.

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