Arihant college of pharmacy
Tuberculosis (TB) remains one of the leading infectious diseases worldwide, requiring effective and timely treatment to prevent morbidity and mortality. Allopathic medicine offers a standardized approach to TB treatment through the use of first-line and second-line antitubercular drugs. These include isoniazid, rifampin, ethambutol, and pyrazinamide as primary agents, often administered in combination to enhance efficacy and prevent resistance. The treatment regimen targets Mycobacterium tuberculosis, leveraging mechanisms such as inhibition of cell wall synthesis, protein synthesis, and bacterial DNA replication. Despite significant success in reducing TB burden globally, challenges such as drug resistance (e.g., multidrug-resistant TB) and adverse drug reactions remain critical issues. Innovations in allopathic therapy, including the development of shorter regimens, adjunctive therapies, and drug susceptibility testing, aim to improve patient outcomes and address these challenges. This abstract highlights the role of allopathic drugs in TB management, emphasizing the need for continued research to optimize treatment efficacy and mitigate resistance.
Tuberculosis (TB) is a highly contagious infectious disease caused by Mycobacterium tuberculosis, which primarily affects the lungs but can also involve other parts of the body. Despite being preventable and curable, TB remains a global health challenge, with millions of cases and deaths reported annually. The advent of allopathic medicine has revolutionized TB treatment, significantly reducing its burden through the use of effective antitubercular drugs. Allopathic TB treatment relies on a standardized drug regimen involving first-line medications such as isoniazid, rifampin, ethambutol, and pyrazinamide. These drugs work synergistically to target the bacteria’s metabolic pathways, ensuring both bactericidal and bacteriostatic effects. The implementation of combination therapy prevents the emergence of drug resistance, a significant concern in TB management. However, multidrug-resistant (MDR-TB) and extensively drug-resistant (XDR-TB) strains pose growing challenges, requiring second-line drugs such as fluoroquinolones and injectable agents. This introduction explores the role of allopathic drugs in combating TB, emphasizing their mechanisms of action, efficacy, and the ongoing challenges in addressing drug resistance, patient adherence, and adverse effects. The significance of optimizing treatment protocols and advancing drug development is crucial to achieving global TB control and eventual eradication.
What is Tuberculosis?
Tuberculosis (TB) is a contagious infectious disease caused by the bacterium Mycobacterium tuberculosis. It primarily affects the lungs (pulmonary TB) but can also spread to other parts of the body, such as the brain, spine, kidneys, and lymph nodes (extrapulmonary TB). TB spreads from person to person through airborne droplets when an infected individual coughs, sneezes, speaks, or sings.
The disease has two major forms:
1. Latent TB Infection: The bacteria remain inactive in the body without causing symptoms. However, latent TB can become active if the immune system weakens.
2. Active TB Disease: The bacteria multiply and cause symptoms, including persistent cough, fever, night sweats, weight loss, and fatigue.
TB is a significant global health concern, with millions of new cases reported annually. While it is curable and preventable, challenges such as drug resistance, inadequate healthcare access, and co-infections like HIV complicate its management. Early diagnosis, effective treatment, and public health measures are essential to controlling TB.
TYPES OF TUBERCULOSIS
Tuberculosis (TB) can be categorized into several types based on the site of infection and the disease progression. The main types are:
1. Pulmonary Tuberculosis (PTB)
2. Extrapulmonary Tuberculosis (EPTB)
3. Latent Tuberculosis
4. Active Tuberculosis
5. Drug-Resistant Tuberculosis (DR-TB)
This type develops when TB bacteria become resistant to standard antitubercular drugs. It includes:
6. Primary and Secondary Tuberculosis
Understanding these types is essential for effective diagnosis, treatment, and prevention strategies.
PATHOPHYSIOLOGY OF TUBERCULOSIS:
Tuberculosis (TB) is caused by Mycobacterium tuberculosis, a slow-growing, aerobic, acid-fast bacillus. The pathophysiology involves a complex interaction between the bacteria and the host immune system, leading to the formation of granulomas, tissue damage, and disease progression.
Stages of Pathophysiology
1. Infection:
2. Immune Response:
3. Latent TB:
4. Active TB:
5. Extrapulmonary Spread:
Role of Allopathic Drugs in TB Treatment:
The goal of allopathic drugs is to eradicate M. tuberculosis while minimizing resistance and adverse effects. The standard treatment follows the Directly Observed Treatment, Short-course (DOTS) strategy, involving two phases:
2. Continuation Phase (4-6 months)
Addressing Drug-Resistant TB
For multidrug-resistant TB (MDR-TB) or extensively drug-resistant TB (XDR-TB), second-line drugs are used:
This allopathic approach, guided by a deep understanding of TB pathophysiology, has significantly improved patient outcomes worldwide.
SYMPTOMS OF TUBERCULOSIS (T.B):
The symptoms of tuberculosis depend on whether it is pulmonary TB (affecting the lungs) or extrapulmonary TB (affecting other organs).
1. Pulmonary Tuberculosis (TB in the Lungs)
This is the most common form of TB. Symptoms include:
2. Extrapulmonary Tuberculosis (TB Outside the Lungs)
TB can affect organs other than the lungs. Symptoms vary based on the affected organ:
3. General Symptoms of Active TB
Regardless of the site, active TB often presents with systemic symptoms:
4. Latent TB
CAUSES OF TUBERCULOSIS:
Tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis, a slow-growing, rod-shaped, acid-fast bacillus. The disease is primarily transmitted from person to person through airborne droplets, though certain risk factors and conditions increase susceptibility.
1. Primary Cause
2. Transmission
3. Risk Factors for TB Infection
Certain factors increase the likelihood of contracting TB:
Environmental and Social Factors
Medical Conditions and Immunosuppression
Lifestyle and Behavioral Factors
Age
4. Other Contributing Factors
TREATMENT OF TUBERCULOSIS USING ALLOPATHIC DRUGS:
The treatment of tuberculosis (TB) in allopathic medicine involves a structured, evidence-based regimen of antitubercular drugs designed to eradicate the Mycobacterium tuberculosis bacteria, prevent resistance, and reduce transmission. The regimen varies based on the type of TB (drug-susceptible or drug-resistant) and the disease’s stage (latent or active).
1. First-Line Drugs (For Drug-Susceptible TB)
For patients with drug-susceptible TB, the treatment follows the Directly Observed Treatment, Short-Course (DOTS) strategy, which is typically divided into two phases:
A. Intensive Phase (First 2 Months)
Combination of four drugs:
B. Continuation Phase (4-6 Months)
Combination of two drugs:
The continuation phase eliminates remaining bacteria and prevents relapse.
2. Treatment for Latent TB
Patients with latent TB are treated to prevent progression to active TB, especially in high-risk groups. Common regimens include:
3. Second-Line Drugs (For Drug-Resistant TB)
For multidrug-resistant TB (MDR-TB) or extensively drug-resistant TB (XDR-TB), treatment involves second-line drugs, which are less effective and have more side effects.
Common Second-Line Drugs:
Newer Drugs for Drug-Resistant TB:
Treatment duration for drug-resistant TB can extend to 18-24 months.
4. Adjunctive Therapies
5. Monitoring and Support
DRUG-RESISTANT TUBERCULOSIS (DR-TB)
Drug-resistant tuberculosis (DR-TB) occurs when Mycobacterium tuberculosis bacteria develop resistance to one or more of the standard antitubercular drugs. This resistance makes treatment more complex, lengthy, and costly.
Types of Drug-Resistant TB
1. Mono-Drug Resistant TB:
• Resistance to a single first-line drug, such as isoniazid or rifampin.
2. Multidrug-Resistant TB (MDR-TB):
• Resistance to at least isoniazid (INH) and rifampin (RIF), the two most powerful first-line drugs.
3. Extensively Drug-Resistant TB (XDR-TB):
• MDR-TB that is also resistant to:
• Any fluoroquinolone (e.g., levofloxacin, moxifloxacin).
• At least one second-line injectable drug (e.g., amikacin, kanamycin, capreomycin).
4. Pre-Extensively Drug-Resistant TB (Pre-XDR TB):
• MDR-TB with additional resistance to a fluoroquinolone, but still susceptible to second-line injectable drugs.
5. Totally Drug-Resistant TB (TDR-TB):
• Rare cases where TB bacteria are resistant to all available first-line and second-line drugs.
Causes of Drug-Resistant TB
1. Incomplete or Improper Treatment:
• Patients not completing their full course of treatment.
• Incorrect dosages or inconsistent drug supply.
2. Transmission of Resistant Strains:
• People can directly contract DR-TB from individuals with resistant forms of TB.
3. Spontaneous Mutation:
• Random genetic mutations in Mycobacterium tuberculosis can lead to drug resistance.
4. Mismanagement of TB:
• Improper drug combinations or inadequate monitoring during treatment.
Diagnosis of Drug-Resistant TB
1. Molecular Testing:
• GeneXpert MTB/RIF: Detects TB and rifampin resistance in a few hours.
• Line Probe Assays (LPA): Detects genetic mutations responsible for resistance to first- and second-line drugs.
2. Culture and Drug Susceptibility Testing (DST):
• Identifies resistance by growing the bacteria in a lab and testing against various drugs (time-intensive).
Treatment of Drug-Resistant TB
1. MDR-TB Treatment
• Second-Line Drugs: Fluoroquinolones (e.g., levofloxacin, moxifloxacin) and injectables (amikacin, kanamycin).
• Newer Drugs:
• Bedaquiline: Inhibits ATP synthase.
• Delamanid: Disrupts mycolic acid synthesis.
• Treatment duration: 18–24 months.
2. XDR-TB Treatment
• Requires a combination of new and repurposed drugs:
• Linezolid: Inhibits protein synthesis.
• Clofazimine: Disrupts bacterial membrane function.
• Bedaquiline and delamanid.
• Treatment may take over 24 months and involves close monitoring for adverse effects.
3. Individualized Therapy
• Drug regimens are tailored based on drug susceptibility test results.
Challenges in DR-TB Management
1. Longer Treatment Duration:
• Standard TB treatment is 6 months, whereas MDR/XDR-TB treatments last 18–24 months.
2. Higher Costs:
• Second-line drugs are expensive and not always readily available.
3. Severe Side Effects:
• Toxicities include hearing loss (injectables), neuropathy (linezolid), and cardiac issues (bedaquiline).
4. Adherence Issues:
• Longer regimens and side effects make it difficult for patients to adhere to treatment.
5. Limited Access to New Drugs:
• Drugs like bedaquiline and delamanid may not be available in resource-limited settings.
Prevention of Drug-Resistant TB
1. Ensuring Treatment Adherence:
• Use of Directly Observed Therapy (DOT) to monitor and support patients during treatment.
2. Prompt and Accurate Diagnosis:
• Early detection of resistance to ensure proper treatment.
3. Infection Control:
• Isolation of patients with DR-TB in healthcare settings to prevent transmission.
4. Public Health Education:
• Educating communities about the importance of completing treatment.
5. Strengthening Health Systems:
• Ensuring consistent drug supply and access to diagnostics tools
ADVANTAGES AND DISADVANTAGES OF USING ALLOPATHIC DRUGS IN TUBERCULOSIS TREATMENT:
Advantages
1. Effective Eradication of Bacteria:
• Allopathic drugs target Mycobacterium tuberculosis effectively, leading to high cure rates when the treatment is followed properly.
2. Structured Treatment Regimens:
• Regimens like DOTS (Directly Observed Treatment, Short-Course) ensure systematic and efficient TB management.
3. Prevention of Relapse:
• Combination therapy eliminates active and dormant bacteria, reducing the chances of recurrence.
4. Wide Availability:
• First-line antitubercular drugs (e.g., isoniazid, rifampin) are widely available and affordable in most regions.
5. Customizable for Drug Resistance:
• Second-line drugs and newer medications (e.g., bedaquiline, delamanid) address multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB).
6. Prevention of Spread:
• Early treatment with allopathic drugs significantly reduces the transmission of TB to others.
7. Shortened Duration:
• Advances in drug regimens have reduced the duration of TB treatment (e.g., from 12–18 months to 6 months for drug-sensitive TB).
8. Supportive Guidelines:
• WHO guidelines ensure standardized and evidence-based approaches to TB management.
Disadvantages
1. Side Effects:
• Hepatotoxicity: Isoniazid, rifampin, and pyrazinamide can cause liver damage.
• Gastrointestinal Issues: Nausea, vomiting, and loss of appetite are common.
• Optic Neuritis: Ethambutol can lead to vision problems.
• Hearing Loss: Injectable second-line drugs like amikacin may cause ototoxicity.
2. Drug Resistance:
• Incomplete or improper adherence to treatment can lead to drug-resistant TB (MDR-TB or XDR-TB), which is harder to treat.
3. Lengthy Treatment Duration:
• Even for drug-sensitive TB, treatment requires a minimum of 6 months, leading to challenges in adherence.
• Drug-resistant TB treatment can last 18–24 months or longer.
4. Cost of Second-Line Drugs:
• While first-line drugs are affordable, second-line and newer drugs (e.g., bedaquiline, delamanid) can be expensive and less accessible in low-income regions.
5. Adverse Drug Interactions:
• Rifampin interacts with many drugs, complicating treatment in patients with comorbidities (e.g., HIV, diabetes).
6. Need for Monitoring:
• Patients require regular follow-ups and testing to monitor drug efficacy and side effects, which can strain healthcare resources.
7. Stigma and Social Challenges:
• Long treatment duration may increase the risk of social stigma and mental health issues, leading to poor adherence.
8. Potential for Toxicity in Vulnerable Populations:
• Pregnant women, children, and individuals with liver or kidney conditions are at higher risk of adverse effects.
CONCLUSION
The use of allopathic drugs for the treatment of tuberculosis (TB) has been a cornerstone in controlling and curing this infectious disease. The most commonly used drugs in tuberculosis treatment include first-line medications like isoniazid, rifampicin, pyrazinamide, and ethambutol. These drugs, when used in combination, effectively eliminate the causative bacteria, Mycobacterium tuberculosis, and significantly reduce the risk of drug resistance.
Key Points in Conclusion:
1. Effectiveness: Allopathic drugs, particularly through Directly Observed Treatment Short-course (DOTS) programs, have proven highly effective in curing TB and reducing transmission.
2. Resistance Concerns: The misuse or incomplete adherence to treatment can lead to multidrug-resistant tuberculosis (MDR-TB) or extensively drug-resistant tuberculosis (XDR-TB), necessitating stricter monitoring.
3. Side Effects: While these drugs are lifesaving, they can have side effects such as hepatotoxicity, gastrointestinal upset, and hypersensitivity, which need careful management.
4. Advancements: Newer drugs like bedaquiline and delamanid have been introduced for drug-resistant TB, showing promise in improving outcomes.
5. Public Health Impact: Allopathic TB treatment has dramatically reduced global TB mortality rates, though challenges like drug resistance, co-infection with HIV, and healthcare access remain.
RESULT
From a total of 68 research documents that reported use of plants for treatment of TB 98 plants species belonging to 82 genera and 49 families were identified. The most frequently reported plant species belonged to family Lamiaceae (n = 8), Euphorbiaceae (n = 7), Cucurbitaceae (n = 6) and Fabaceae (n = 6).
Croton macrostachyus, Allium sativum, and Myrsine Africana were the most often mentioned anti-TB medicinal plants. Shrubs (35.7%) and trees (29.6%) were reported as dominant growth forms while plant roots (31.6%) and leaves (28.6%) were frequently used plant parts for the preparations of the treatment. The most favored administration route was oral (59.1%). About 87% of the preparations were made from fresh plant materials. No experimental/clinical evidence was presented for 79.6% (78/98) of the reported plants to support their anti-mycobacterial activities.
REFERENCE
Sarthak Mote, Tejaswini Gurud, Sayyaad Kaifali Adam, Ajim Shaikh, Sachin Sapkal, Galgate K. M., Swapnil Wadkar, Akash Balid, Saurabh Walunjkar, Alopathy Drug Used Treatment for Tuberculosis (Tb), Int. J. Sci. R. Tech., 2024, 1 (12), 53-57. https://doi.org/10.5281/zenodo.14306399