Q : What is DOTS TB?
A : DOTS TB is a goverment program to eradicate tuberculosis, it stands for Tuberculosis Directly Observed Treatment Short Course
Q : What is TB?
A : Tuberculosis (TB) is an infectious disease that is caused by the Mycobacterium tuberculosis bactery.
Q : I heard there's a bone TB disease. Doesn't TB only infect the lung?
A : Wrong. TB usually does infect the lung because it's the organ that faces the outer environment, but Mycobacterium tuberculosis can also attack other organs. Opik had a lecture from a RSHS docter that found cases where TB struck bones, brain, testis, skin, stomach, lymph node, etc. So be carefull if you have an open wound, it can be an entrance for Mycobacterium tuberculosis.
Q : How does TB spread?
A : They usually by droplet, the small drops that you blow when you cough or breath. The funny thing is, even the size of Mycobacterium tuberculosis is big, it rides the small droplets, while flu viruses ride the big ones. No wonder the spreading can be far away.
Q : I have many people around me have TB, but why I'm not? Am I immune?
A : There are many people with TB but aren't sick. From the lecture opik had, 1/3 people in indonesia has been infected with droplets. only 1/3 of that get an infectious TB and only 5% from those 1/3 get the real TB. This is because our immune system keep them in check, so a granuloma is formed. As long as the immune system is in good condition and Mycobacterium tuberculosis is dormant (sleeping), the TB won't surface.
Q : If I have TB, can I be healthy again?
A : Ofcourse you can , if you follow the medication with compliance and untill it's finished. Don't stop in the middle please.
Q : How do we cure the disease?
A : Well, with the DOTS, it depends on the patient, is he a first timer, has had a TB in the past, or problematic resistent one.
Q : If the patient has got the TB for the first time, what is the cure?
A : for the first two months, consume these drugs every day:
-INH (Isoniazid) (H)
-RIF (Rifampisin) (R)
-PZA (Pirazinamid) (Z)
-EMB (Etambutol) (E)
Then test your sputum, is it positive or negative. If it's still positive, continue consuming the drugs for 1 month. If it's negative, continue to stage 2
At stage 2, for the next 4 month's, consume these drugs 3 times a week :
-INH (Isoniazid) (H)
-RIF (Rifampisin) (R)
Q : How about patients that had TB before?
A : For the first two months, use these drugs everyday:
-(H)
-(R)
-(Z)
-(E)
-SM (Streptomisin) (S)-this one will be injected
and then test the sputum at the end of the second month, is it positive or negative. If it's still positive, continue using R,H,E,and Z for 1 month. If it's negative, continue to stage 2.
At stage 2, for the next 5 monts, use these drugs 3 times a week :
-(H)
-(R)
-(E)
Q : How about children?
A : For kids, you cannot give them ethambutol, because it will damage their eye. For the first two months, use these drugs everyday :
-(H)
-(R)
-(Z)
dan then continue to satge 2, where for the next 4 months, use these drugs everyday:
-(H)
-(R)
Q : How much is the dosage of these TB drugs?
A :
Q : how does these drugs work?
A : in short they work like this
-Isoniazid
killing the bacteries that are active multiplicating
-Rifampisin
killing semi dormant bacteries
-Etambutol
make the bacteries quiet
-Pirazinamid
Kill the bacteries in acid
-Streptomisin
for relapse/fail cases
for more explanation, just see wikipedia
Q : I heard there are other drugs for TB, how about it?
A : there are. The drugs that I have esplained are the first line drugs for TB, there are also second liners like:
-Aminoglikosida (kanamisin dan amikasin)
-Polipeptida (kapreomisin, PAS, sikloserin)
-Tioamida (etionamida dan protionamida)
-Fluorokuinolon (moksifloksasin,levofloksasin dan gatifloksasin).
There's also a research by prof. Elin Yulinah Sukandar in the Cibadak Lung Hospital where it is discovered that mengkudu and ginger can be used to cure TB, but she didnt give the strength and frequency of the drug use. But it's said that Kimia farma or Kalbe Farma will be releasing the product, named fortibi.
Q : Why should we cure TB with DOTS?
A :
-Individual drug can't kill the resistant bactery, resulting in failure eliminating the disease.
-There's another TB bacteria population (that shows a different pattern in it's drug response) in the patient
-COmbination Theraphy and the newer drug that is more effective can considerably control the disease because even the bacteria is resistant to one drug, it isn't resistant to the other drugs.
Also, it's better to use the first liners first, because it's potent, cheap and the therapy duration is short. But if there's a problem ( like allergy and resistance), then the second liners can be used.
The second liners are more toxic, more expensive, less effective, should be monitored, and the therapy duration is longer. There are also stories from doctors about patients that have hallucination, sing a song and dance by themselves, having amnesia and such things. And remember, most of them should be injected.
Q : How about the cost? is it expensive?
A : No, it;s cheap, and because it's indonesia national program, you could get them for free. Except for the second liners, that some are not covered.
Q : Why are there cases where the TB therapy doesn't follow these guides? like doctor's prescription that aren't like what you say and patients that stop before finishing.
A : Yup, that's a deviation. If there are no problems, the guide above should be followed, because there is a possiblity a resistance problem emerge and the disease become immune and furious. Patients should also remember that the Mycobacterium tuberculosis is still there even if he feel's that he is already healthy, and it wait's to attack again, so it should be cured until the end.
Q : Are there problem that should be considered?
A : Yes, Rifampisin will make your urine red, but only that, so don't worry. Etambutol can also cause your view become blurry. INH depletes your B6 vitamins, so you should eat foods or drink containing it more or supplements. And, pregnant or breast feeding moms are safe to use these TB drugs, except streptomisin. The baby that is nursed should get INH to prevent it getting TB from it's mom.
-from ITB and guest lectures in the ITB apothecary program.
Tidak ada komentar:
Posting Komentar