TUBERCULOSIS (also known as TB) is an infection caused by the mycobacterium tuberculosis.
It's airborne and can spread from one person to the next when patients infected with the bacteria cough, sneeze, speak or laugh. Therefore, early detection is crucial.
Apart from the lungs, mycobacterium tuberculosis can attack other parts of the human body, including the kidneys, spine and gastrointestinal tract.
Everyone is at risk of infection but not everyone will exhibit symptoms of the disease. There are, however, some risk factors that increase the incidence of an infection.
These include individuals who are in close contact with tuberculosis patients, be they family, close relatives or work colleagues.
Individuals with a compromised immune system such as diabetics; HIV patients; those with chronic obstructive pulmonary disease, chronic kidney disease and cancer; and malnourished individuals are also at risk.
Pregnant women and children fall under the at-risk group too as are heavy smokers and substance abusers (heroin, amphetamine and even alcohol).
People living in an area with a dense population, where community members are always in close contact, such as prisons, shelter homes and slums, are also at risk.
Active tuberculosis patients who are undergoing treatment must wear face masks regularly and practise proper cough etiquette to prevent the spread of the infection.
IS TB CURABLE?
The duration of treatment is at least six months and comprises two phases. In the intensive phase, the patient needs to take four types of anti-tuberculosis medicines daily for two months. These are isoniazid, rifampicin, ethambutol and pyrazinamide.
In the maintenance phase, the patient needs to take two types of anti-tuberculosis medicines for the remaining four months. These are isoniazid and rifampicin.
The actual duration of treatment depends on the type of organ affected or the stage of infection.
The effectiveness of treatment depends on the adherence of the patient to medication. Having to take several tablets at one time may result in non-compliance.
Currently, there is a newly formulated tablet that contains medicines for the first phase of tuberculosis treatment.
This fixed-dose combination tablet allows the patient to consume only one tablet daily, which results in improved compliance.
The side-effects of anti-tuberculosis medications are manageable. All medicines have the potential to cause side-effects, and the antimicrobials used to treat tuberculosis are no different. Pharmacists need to counsel patients before commencing anti-tuberculosis therapy. The side-effects include nausea and vomiting.
A patient may take the medications at different times to reduce these side-effects. Isoniazid and rifampicin can be taken in the morning while ethambutol and pyrazinamide can be taken in the evening.
Alternatively, the patient can consume soft food, such as porridge or pudding, before taking the medication. This type of food may also serve as fluid replacement to prevent dehydration from frequent vomiting.
Other than nausea and vomiting, isoniazid and rifampicin may cause itchiness and rashes. The patient can treat the allergic reaction with antihistamines.
If the patient develops chronic rashes all over the body, accompanied by fever for more than three days, the patient must seek immediate medical attention.
Rifampicin may cause orange or red discolouration of the urine, tears and sweat. Patients should not be alarmed when experiencing these side-effects. They should also not wear contact lenses throughout the treatment phase to avoid staining the lenses.
Some other side-effects of anti-tuberculosis treatment are numbness, a tingling feeling on the fingers and toes, red and green colour blindness, joint pain and liver injury (which leads to jaundice and hepatitis).
COMPLIANCE IS CRUCIAL
Compliance with anti-tuberculosis medicines is key to preventing the development of an antimicrobial or antibiotic-resistant tuberculosis infection, which can lead to multidrug-resistant tuberculosis (MDR-TB).
MDR-TB is difficult to treat and needs at least 18 months of antimicrobial treatment.
Additionally, second-line drugs that are required to treat MDR-TB often come with more undesirable side effects.
The following tips may help patients to adhere to treatment:
• Consume medications at the prescribed dose and frequency.
• Use a calendar, timetable or alarm. clock as a reminder to take medication;
• Do not reduce the dosage of the medicines or stop taking the medication without your doctor or pharmacist's advice.
• Ensure anti-tuberculosis medications are sufficient at all times.
• Never miss any appointment with your doctor.
• Discuss any side-effects experienced with your doctor or pharmacist.
Family members should always motivate the patient to be compliant towards TB treatment. The patient must remember that effective TB treatment is crucial not only for them but also for their family members and society.
For inquiries regarding the use of medicines, the National Pharmacy Call Centre (NPCC) can be reached at 1800-88-6722 (toll-free) weekdays from 8am to 5pm.
*The writer is a pharmacist with the Ministry of Health Malaysia.