Principles of chemotherapy for pulmonary tuberculosis

When treating many diseases, we want to use a treatment principle, and this principle is generally followed. It can cure the disease without any side effects and other complications. Only in this way can we achieve the goal of truly benefiting the patient. When treating a disease like tuberculosis, it is necessary to follow a treatment principle. So what are the chemotherapy principles for tuberculosis?

When treating many diseases, we want to use a treatment principle, and this principle is generally followed. It can cure the disease without any side effects and other complications. Only in this way can we achieve the goal of truly benefiting the patient. When treating a disease like tuberculosis, it is necessary to follow a treatment principle. So what are the chemotherapy principles for tuberculosis?

1. Principles and plans for the use of anti-tuberculosis drugs

Correct selection of medication, formulation of reasonable chemotherapy plans, adherence to chemotherapy principles and scientific management are the most effective measures to cure patients, eliminate infection and control the prevalence of tuberculosis. The chemotherapy regimen should be formulated or selected based on the patient's previous treatment (including initial or retreatment, anti-tuberculosis drug compatibility and application), bacterial excretion, drug resistance, lesion extent, and the presence of concomitant diseases and complications. Any regimen includes two different treatment phases: ① Intensive treatment phase: 3 to 4 drugs are used in combination for 8 to 12 weeks in order to kill various bacteria as quickly as possible to ensure successful treatment. ② Consolidation treatment stage: 2 to 3 or 4 drugs are used in combination. Its purpose is to consolidate the therapeutic effect achieved in the intensive stage and continue to kill residual bacteria. There are three types of medication: ① Daily medication throughout the course; ② Daily medication during the intensive period and intermittent medication during the consolidation period; ③ Intermittent medication throughout the course.

1. Chemotherapy regimen for newly treated sputum-positive pulmonary tuberculosis

A short-term chemotherapy regimen was selected as follows: ①2HRZS(E)/4HR; ②2HRZS(E)/4HRE; ③2HRZS(E)/4H3R3; ④2H3R3Z3S3(E3)/4H3R3; ⑤2HRZ/4HR.

2. Chemotherapy regimen for retreatment of sputum-positive pulmonary tuberculosis

①2HRZES/6HRE; ②2HRZES/6H3R3E3; ③3H3R3Z3S3/5H3R3E3; ④3HRZEO/5H3L1O3.

3. Chemotherapy regimen for newly treated sputum-negative pulmonary tuberculosis

①2HRZ/4HR;②2HRZ/4H3R3;③2H3R3Z3/4H3R3.

4. Chemotherapy regimens for drug-resistant and multidrug-resistant tuberculosis

(1) For those resistant to isoniazid: ①2REZ/7RE; ②2RES/10RE.

(2) For those resistant to isoniazid (H) and streptomycin (S): 2HRZES/1HRZE/6RE.

(3) Those resistant to isoniazid (H), ethambutol (E) or streptomycin (S): 3RTH (O) ZS (KM/CPM)/6RTH (O).

(4) Those resistant to isoniazid (H) and rifampicin (R): 3THOEZAK (SM/KM/CPM)/18THOE (P).

(5) Those who are resistant to isoniazid (H), rifampicin (R), ethambutol (E), and streptomycin (S) or those who are not resistant to streptomycin (S): 3THOCS (P) ZS (KM/AK/CPM)/18THOCS (P).

(6) Before the results of the drug sensitivity test are obtained, the following regimens can be used as reference: ①3THZOS (KM/AK/CPM)/18THO; ②3THOEZSM (AK/KM/CPM)/18THOE (P).

2. Extending the indications of anti-tuberculosis chemotherapy

The course of anti-tuberculosis chemotherapy should be appropriately extended (total course of treatment should be no less than 1 year) for patients with tuberculous meningitis or extrapulmonary tuberculosis of important organs, diabetes, pneumoconiosis, immune dysfunction (including HIV infection and AIDS patients), organ transplantation and bone marrow transplantation.

3. Indications for multidrug-resistant tuberculosis regimens

Patients with any of the following clinical conditions, who have not obtained drug sensitivity results or are not yet in a position to undergo drug sensitivity testing, should be considered suspected multidrug-resistant tuberculosis (MDR-TB) patients and treated according to the MDR-TB regimen.

1. Patients with sputum positive bacteria who have failed initial chemotherapy and still excrete bacteria after standardized retreatment regimen.

2. Those who have recently received more than 2 courses of chemotherapy and are still excreting bacteria.

3. Patients who have been excreting bacteria for more than 2 years despite irregular anti-tuberculosis treatment.