Preventing and treating tuberculosis

An estimated 200,000 to 600,000 Filipinos have active tuberculosis (TB). This condition makes the person sick and is contagious to others. The Philippines is in the top 22 (we’re No. 9) high-burden tuberculosis (TB) countries in the world.

TB is an infection caused by bacteria that usually affect the lungs. These bacteria, called Mycobacterium tuberculosis, can spread to another person through tiny droplets spread by coughing and sneezing.

For this article, we will look into the diagnosis and treatment of TB. Two tests usually required of patients suspected of having TB are the following:

• Chest X-ray: If your doctor suspects TB, he/she will order a chest X-ray. This may show white flakes or patches usually in the upper part of the lungs. This may mean an active TB infection or a past infection. To further clarify, your doctor will ask for your symptoms and may request for a sputum test.

• Sputum test: Your doctor may ask you to submit a sample of your sputum — the mucus that comes up when you cough. The samples are then tested for TB bacteria. However, this test isn’t foolproof. Even if the person has TB, the sputum test will only be positive in 50-percent of cases.

If you are diagnosed with active TB, then you must absolutely take anti-TB medicines. There are no ifs and buts. It’s for your own good and for the good of the people around you. If you don’t take the medicines, then you will be infecting an average of 10 persons a year, including your loved ones and children.

Treatment for TB is a bit more difficult compared to ordinary infections since it will take approximately six months to completely eradicate the bacteria. Some more serious TB infections will require nine months of treatment. Your doctor is the best person to guide you on the correct treatment. Never self-medicate. This is the worst thing you can do. It will only strengthen the bacteria inside you and make you resistant to the medicines.

The six-month TB treatment usually requires three or four drugs, including Isoniazid, Rifampin, Ethambutol, and Pyrazinamide. Some preparations have the three or four drugs combined in one tablet (such as Myrin P Forte and Myrin P).

The usual TB treatment regimen is to take the four-drug combination (such as Myrin P forte) for two months, followed by a two- or three-drug combination (such as Myrin P) for four months. Approximately two to five tablets of the medicines are taken daily depending on your body weight.

Take all TB medications one hour before meals. It is ideal not to break the dose of the drug. Your doctor will also require blood tests (SGPT, SGOT) to check for possible liver side effects due to the drugs.

These side effects aren’t common, but some TB medicines can occasionally be harmful to the liver. In addition, the color of the urine will change from yellow to orange. This is a normal reaction to the treatment course.

You should, however, consult your doctor if you experience any of these: nausea, vomiting, loss of appetite, yellowing of the skin, or fever for more than three days. Your doctor will know what to do.

Some patients can’t tolerate taking all four drugs an hour before meals. In such cases, your doctor may adjust the intake of your medicines. Don’t do this on your own. Always seek your doctor’s advice.

Tips for active TB patients

• Don’t infect your family and friends. Follow your doctor’s advice and take the necessary medicines. After three weeks of taking the drugs, you are not contagious anymore to the people around you. Protect your family.

• Stay home during the first three weeks of treatment. Don’t go to school, work or come in close contact with other people. Your saliva and phlegm can infect others.

• Keep your windows open. TB bacteria can spread via air-conditioning in a closed room. If it’s not too hot, use a fan to blow the air outside.

• Cover your mouth with a tissue when you cough, sneeze or laugh too hard. Then throw the tissue away in a sealed container.

• Consider wearing a face mask during the first three weeks of treatment.

• This is important: Complete the six- or nine-month course of your medicines. Do not stop your medicines without your doctor’s permission. Doing so will cause the TB bacteria to mutate and come back in a stronger and more virulent form.

• Stay positive. Continue with your normal activities and hobbies and seek your family’s support. The good news is that after you finish your treatment course, you will most likely be completely healed. Observe a healthy lifestyle to stay well.

Tips for health workers

• Use the DOTS strategy, which stands for Directly Observed Therapy Short Course. This means that a health worker or family member directly observes the patient taking his/her medicines the whole time. Hence, there’s no excuse to miss taking the medicines.

• If the patient cannot complete treatment for some reason, some experts believe it is better not to start treatment to avoid resistance.

• The allowance for patient non-compliance to medicines is only two weeks maximum. Otherwise, the treatment course should be started all over again.

• Patients are ideally checked up monthly. During initiation of treatment, follow up on the patients after a week to see if there are drug side effects.

• After six months, most patients will be cured already. If two years have elapsed and the patient is still healthy, then long-term cure is anticipated. Relapse (repeat infection with TB) occurs in one to two-percent of cases.

Remember, work with your health center doctor or pulmonary doctor to make sure you get well from TB. Good luck!