Tuberculosis (or also known as TB) is an infection caused by mycobacterium tuberculosis. Tuberculosis is an airborne disease, and it can spread from one person to the next when patients infected with the bacteria coughs, sneezes, speaks or laughs. Therefore, early detection of tuberculosis is crucial.

 

Apart from the lungs, mycobacterium tuberculosis can also attack and infect other parts of the human body, including the kidneys, spine, and gastrointestinal tract.

 

Who Can Get Tuberculosis?

 

Everyone is at risk of infection, but not everyone will demonstrate tuberculosis disease symptoms. There are, however, some risk factors that increase the incidence of an infection, as follows:

1. Individuals who are in close contact with tuberculosis patients, be it family, close relatives or work colleagues,

2. Individual with a compromised immune system (such as diabetic patient, HIV patient, chronic obstructive pulmonary disease patient, chronic kidney disease patient, cancer patient and malnourished patient),

3. Pregnant women and children are also at risk because of a weakened immune system,

4. Heavy smokers and substance abusers (heroin, amphetamine, alcohol),

5. People live in an area with a dense population, where the community members are always in close contact, such as; prisons, shelter homes and slums.

Active tuberculosis patients who are on treatment must wear face masks regularly and practice proper cough etiquette to prevent the spread of the infection.

 

Is tuberculosis curable?

 

The duration of treatment is for at least six months and comprises of two phases:

1. Intensive phase (two months): The patient needs to take four types of anti-tuberculosis medicines daily for two months. These antimicrobials are isoniazid, rifampicin, ethambutol and pyrazinamide.

2. Maintenance phase (four months): The patient needs to take two types of anti-tuberculosis medicines for the remaining four months. These antimicrobials are isoniazid and rifampicin.

 

The actual duration of treatment depends on the type of organ affected or the stage of infection.

The effectiveness of the treatment depends mainly on the adherence of the patient to medication therapy. Having to take several tablets of medication at one time might cause noncompliance among patient. 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.

 

Side Effects of Anti-Tuberculosis Medications are Manageable 

 

All medicines have the potential for causing side effects, and the antimicrobials used to treat tuberculosis are no different. Thus, pharmacists need to counsel the patients before commencing anti-tuberculosis therapy. Among the side effects usually experienced by patients when undergoing anti-tuberculosis treatment are nausea and vomiting.

 

The patient may take the anti-tuberculosis medications at different times to reduce the risk of nausea and vomiting. The patient could take isoniazid and rifampicin in the morning. Then, the patient takes the other medicines, which are ethambutol and pyrazinamide, in the evening.

 

Alternatively, the patient could take soft food, such as porridge or pudding, before taking the medication. The food may also serve as a fluid replacement to prevent dehydration from frequent vomiting episodes.

 

Other than nausea and vomiting, isoniazid and rifampicin might cause itchiness and rashes. The patient can treat the allergic reaction with antihistamines. On the other hand, 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 might cause orange or red discolouration of urine, tears and sweat. The patient should not be alarmed when experiencing these side effects. They should not wear contact lenses throughout the treatment phase to avoid staining on the lenses.

 

Some other side effects of anti-tuberculosis are numbness, a tingling feeling on fingers and toes, red and green colour blindness, joint pain and liver injury (which lead to jaundice and hepatitis).

 

The majority of the side effects listed here are manageable and treatable. The patient who experiences severe and unbearable side effects must consult with a doctor or pharmacist immediately.

 

Why is Compliance with Anti-Tuberculosis Medicines So Crucial?

 

Compliance with anti-tuberculosis medicines is key to preventing the development of an antimicrobial/antibiotic-resistant tuberculosis infection, which can lead to multidrug-resistant tuberculosis (MDR-TB).

 

MDR-TB is difficult to treat and needs a longer duration of antimicrobial treatment, of at least 18 months. Additionally, second-line drugs that are required to treat MDR-TB often come with more undesirable side effects.

 

Advice for Patients

 

Taking the anti-tuberculosis medicines correctly as instructed by the doctor or pharmacist is essential to ensure treatment effectiveness. The following tips might help patient to adhere to treatment:

1. Consume the medications as the prescribed dose and frequency,

2. Use calendar, timetable or alarm clock as a reminder to take medication,

3. Do not reduce the dosage of the medicines; or stop taking the medication without the doctor or pharmacist’s advice,

4. Ensure the anti-tuberculosis medications are sufficient at all times,

5. Never miss any appointment with the doctor,

6. Discuss any side effects experienced with the doctor or pharmacist.

 

The family members should always motivate the patient to be compliant toward TB treatment, despite having side effects. The patient must remember that an effective TB treatment is crucial not only for them but also for the family members and society.

 

Please call the National Pharmacy Call Centre (NPCC) at the toll-free line 1800-88-6722, weekdays from 8 am to 5 pm if there are any inquiries regarding the use of medicines.

 

Prepared by : 

Izzati Yussof

Pharmacist

Ministry of Health Malaysia