Tuberculosis : Curing TB

by Food and Drug Administration (FDA)

(Page 3 of 3)

A number of drugs given together are used to cure TB. Kopanoff says that CDC recommends a six-month course with INH and rifampin given concurrently. Pyrazinamide is also given along with these drugs for the first two months only. Persons who have tuberculosis and AIDS or HIV infection require at least nine months of medication.

Streptomycin is still an important anti-TB drug, but its use is limited because it must be given by injection. In cases where TB bacteria have become resistant to these drugs, other drugs, such as ethambutol (an antimycobacterial agent), are added. After a few weeks of antibiotic therapy, the TB patient can no longer infect others.

Even though INH and rifampin have not been found to cause birth defects in animals, they are used to treat pregnant women only when therapeutically necessary and usually are not given to pregnant women with latent tuberculous infection.

Adverse Effects

It's no wonder that drugs powerful enough to knock out tough TB bacteria can also have serious adverse reactions. The most commonly used anti-TB drugs — INH, rifampin and pyrazinamide — can cause liver damage. Before they are administered, tests to measure liver enzymes and kidney function and other blood tests should be run, to serve as baselines for later comparison.

INH is especially dangerous to alcoholics and older adults, while rifampin interferes with the action of a number of widely used drugs, such as digitalis, certain anticoagulants, oral contraceptives, and diabetes drugs. Streptomycin may cause some hearing loss, while ethambutol may affect vision, with a loss of acuity and decreased ability to distinguish between red and green.

Vaccine

A vaccine for tuberculosis, called BCG for Bacille Calmette-Guerin, is available but not widely used in this country. Made from live, but weakened, cow tubercle bacilli, the vaccine didn't protect adults against pulmonary TB in a large clinical trial in India. However, because it appears to offer some protection to children, the World Health Organization recommends its use for newborns in developing countries. The prevalence of TB in the United States is generally considered to be too low to justify widespread immunization with BCG. Several other vaccines are currently under development.

Just as smallpox was eradicated through vaccination worldwide, a better, more effective vaccine might spell an end to this ancient but enduring disease.

Old-Fashioned Romance

To think that it was once considered romantic to look tubercular. Healthy and athletic women may be today's feminine ideal, but in the late 18th and early 19th centuries, aristocratic women strove to be thin, pale and delicate. To that end, they starved themselves (anorexia is nothing new), used white powder on their faces, and cultivated the languid, listless air of those drained of energy by the disease. Since TB was so prevalent then, it's not surprising that for some the wish became the reality.

Maybe the disease was romanticized because it cut such a wide swath through the ranks of the talented and famous of those times. TB was the most common cause of death in the Western world up to the time of the American Revolution.

Frederic Chopin died of the disease, as did John Keats, Emily Bront, Edgar Allan Poe, Henry David Thoreau, and Anton Chekhov. Had Percy Bysshe Shelley not drowned in a boating accident at age 30, he would surely have died of TB, because he had an active case. Robert Louis Stevenson sought the cure at Saranac, then moved to Samoa, where he died at age 44. Ralph Waldo Emerson lost his first wife to the disease, as well as brothers and other family members, but successfully fought it himself. TB bedeviled Emerson descendants until antibiotics were discovered. TB also ran like wildfire through the Keats, Bront, Thoreau and Trollope families. Before Robert Koch, the eminent German bacteriologist, proved in 1882 that bacteria caused TB, many considered the disease to be hereditary.

Maybe looking tubercular had a certain cachet, but it's hard to believe those ladies were unaware of what the disease was really like. In the early stages, TB is symptomless. Gradually, however, the TB patient feels tired, may run a fever, have night sweats, lose weight. This wasting away, in which the body is literally consumed by the disease, is the reason TB was once called consumption. As the disease progresses, the patient may cough up blood-tinged sputum. Chest pain is common, and shortness of breath develops when the lungs are heavily ravaged. And if a lung cavity erodes an artery, massive hemorrhage can occur.

About the Author

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