Tuberculosis: A Persistent Foe and the Power of Prophylaxis
Tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis, remains a significant global health burden. While curable, its chronic, often asymptomatic nature, and the emergence of drug-resistant strains necessitates a multi-pronged approach, including effective prophylaxis. Let’s explore the intricacies of TB prophylaxis:
1. Types of Prophylaxis in TB:
- Primary Prophylaxis: Aims to prevent the initial infection in individuals exposed to someone with active TB but lacking active disease themselves.
- Isoniazid (INH): The gold standard for primary prophylaxis, with effectiveness reaching 80-90%.
- Rifampicin: Can be used alone or in combination with INH. Shorter duration options are available with higher efficacy.
- Secondary Prophylaxis: Prevents reactivation of latent TB infection and progression to active disease in individuals with a positive tuberculin skin test (TST) or interferon-gamma release assay (IGRA) but no active symptoms.
- Same medications as primary prophylaxis, though duration may be shorter.
2. Target Groups for Prophylaxis:
- Close contacts of individuals with active TB: Household members, healthcare workers, and others with significant exposure.
- Individuals with immunocompromised conditions: HIV/AIDS, malnutrition, diabetes, and certain medications can increase susceptibility to TB reactivation.
- Certain high-risk populations: Migrants from high-TB-burden countries, children living in high-risk settings, and individuals with previous TB infection.
3. Choosing the Right Prophylaxis Regimen:
- Individual patient factors: Age, comorbidities, potential drug interactions, and past history of TB or INH intolerance influence regimen selection.
- Local TB epidemiology: Drug-resistant strains may necessitate alternative medication choices.
- Duration of prophylaxis: Varies depending on risk factors and chosen medication, typically ranging from 3-6 months for primary prophylaxis and shorter durations for secondary prophylaxis.
4. The Challenges of Prophylaxis:
- Compliance: Long treatment durations and potential side effects can negatively impact adherence.
- Drug Resistance: Emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB strains complicates prophylaxis and treatment.
- Limited Resources: Access to diagnostics and preventive medication may be limited in low-resource settings.
5. The Significance of Prophylaxis:
Despite these challenges, TB prophylaxis remains a crucial public health tool. Early intervention can prevent active TB cases, reduce transmission, and ultimately lessen the global burden of this disease.
Suggested readings:
Third Year Pharm D Subjects
| 3.1 | Pharmacology-II |
| 3.2 | Pharmaceutical Analysis |
| 3.3 | Pharmacotherapeutics-II |
| 3.4 | Pharmaceutical Jurisprudence |
| 3.5 | Medicinal Chemistry |
| 3.6 | Pharmaceutical Formulations |
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