Corona pandemic leads to more tuberculosis deaths
According to the World Health Organization (WHO), around 1.5 million people died from tuberculosis in 2020. The year before it was 1.4 million. The corona pandemic has thrown back the fight against tuberculosis (TB or Tbc), among other things, due to lockdowns and the overburdened health system. It was the deadliest infectious disease after Covid-19 in 2020. TB, also known as consumption, is particularly common in poorer countries.
Cough infection
The causative agent of tuberculosis is a mycobacterium. Most commonly, Mycobacterium tuberculosis causes the infection. Transmission usually occurs through droplet infection when coughing or sneezing. The more people live together in a small space, the greater the risk of infection.
But not all carriers of the bacterium also have symptoms and not all sick people are contagious. Only 5 to 15 out of 100 infected people actively develop tuberculosis. An intact endogenous defense can render the pathogens harmless, but the bacteria often lie dormant in the body for years.
Danger with weakened immune system. The disease breaks out particularly in people with weakened immune systems, e.g. B. in the chronically ill, people with poor nutritional status, HIV-positive or people who have to take immunosuppressive drugs. The bacteria most commonly attack the lungs (pulmonary tuberculosis), but foci of inflammation can also form in the brain or in bones and joints.
signs of infection. The symptoms are uncharacteristic and at the beginning of the disease include a slight fever, cough, night sweats, unwanted weight loss and general weakness. Only when the focus of inflammation in the lungs spreads and destroys lung tissue does the affected person cough up mucus, which can be bloody (open pulmonary tuberculosis). This form of tuberculosis is highly contagious. A chest x-ray can reveal possible sources of inflammation in the lungs.
Tuberculosis is rather rare in Germany
The infectious disease is particularly widespread in certain regions of Africa, in the western Pacific region and in Southeast Asia. In Eastern Europe, multidrug-resistant tuberculosis in particular has increased in recent years. The disease is rare in Germany. According to the Robert Koch Institute, almost 5 new cases per 100,000 inhabitants were registered in 2020. After an increase in tuberculosis cases in 2015 due to increased immigration, the numbers in Germany have been falling again since 2019.
Resistant bacteria – difficult therapy
Mycobacteria divide slowly, giving them enough time to develop mechanisms that make them resistant to antibiotics. For example, the bacteria form proteins that smuggle the antibiotics used out of the bacterial cell or render them ineffective.
Therefore, the treatment of tuberculosis – even if the course is actually uncomplicated – is very complex. This is because several antibiotics that are specifically effective against mycobacteria (so-called antituberculosis drugs) have to be used over a long period of time.
Standard therapy with four different active ingredients
First four, then two. According to current WHO recommendations, the standard therapy for uncomplicated pulmonary tuberculosis lasts six months. At the beginning you have to take the four antibiotics for two months Rifampicin (Emerfat), Isoniazid (isocide), Ethambutol (EMB-Fatol), Pyrazinamide (pyrazinamide 500 mg JENAPHARM). In the following four months, only the two active ingredients rifampicin and isoniazid are used.
Avoid resistance. It is important to strictly adhere to these therapy specifications, otherwise there is a risk that the bacteria will become insensitive (resistant). The four remedies differ in their mechanisms of action and sites of action. This is important in order to reach all pathogens, including those that are already resistant to one of the active ingredients.
How does rifampicin work?
Rifampicin kills mycobacteria, but care must be taken to ensure that there are no resistances. The antibacterial activity of rifampicin is essential to the success of tuberculosis treatment. With resistance to rifampicin, treatment becomes more complicated and lengthy. The prospect of recovery is then also much worse.
Calculate dose. The dosage of rifampicin is based on body weight. It is recommended for children under 12 years of age between 10 and 20 milligrams of rifampicin per kilogram of body weight, for children and adolescents over 12 years of age and adults between 8 and 12 milligrams of rifampicin per kilogram of body weight. For children under 6 years of age, a syrup is available as a child-friendly form of preparation. A child weighing 5 to 10 kilograms needs 100 milligrams of rifampicin per day, which corresponds to one measuring spoonful of the syrup. Adults with a body weight of 50 kilograms or more receive 600 milligrams of rifampicin per day. The antibiotic can also be used in pregnant women. Rifampicin should be taken on an empty stomach (half an hour before or two hours after a meal) at the same time as the other means of combination therapy.
Adverse Effects of Rifampicin
Rifampicin – especially in combination with the other active ingredients – can Leber damage. This is particularly important in patients with liver damage. If possible, you should not take any other medicines that can cause liver damage during treatment. These include both self-medication, such as Paracetamol (at Pain and fever), but also those prescribed by the doctor, for example Methotrexate (at Psoriasis or rheumatoider Arthritis).
In order not to put additional strain on the liver, you should also avoid alcohol during treatment. Typical signs of severe liver damage are dark discoloration of the urine, light discoloration of the stool or developing jaundice (indicated by yellowing of the eyes) – often accompanied by severe itching all over the body. If any of these signs of disease, characteristic of liver damage, appear, you must see a doctor immediately.
The remedy can also do that Kidneys damage. If you have increased or decreased urination, if your skin smells like urine, if you have new or worsening water retention in your legs (oedema) or pain in the kidney area, you should see a doctor within a few days and have your kidneys examined.
Rifampicin may affect about 1 in 1000 people Blutbildung have. This can manifest itself, for example, in the form of nosebleeds due to a too low number of blood platelets. Then the doctor should examine your blood count.
Note the following information
In order to detect damage to the liver, kidneys or blood formation in good time, it is necessary for the doctor to regularly check the blood, liver and kidney values during therapy.
When body fluids, such as tears, saliva, and urine, turn orange-brown, it’s a harmless side effect of rifampicin. It goes away after the end of treatment and does not result in any permanent damage.
Rifampicin reduces the effectiveness of many drugs because it greatly accelerates their breakdown. For example, the effect of certain drugs against HIV (ritonavir, saquinavir, nevirapine) and fungal infections (voriconazole, itraconazole, fluconazole) is weakened so much that they are no longer sufficiently effective. Also epilepsy drugs, drugs against cardiac arrhythmias, anticoagulants such as Phenprocoumon and warfarin (for thrombosis) or the pill Contraception can be significantly impaired in their effectiveness if rifampicin is used at the same time.
Conversely, the effect of rifampicin can be influenced by the use of other medicines, so that dose adjustments are often necessary. For example, delayed Co-trimoxazole (at urinary tract infections) the breakdown of rifampicin, then the risk of side effects increases. Therefore, tell any doctor you see while being treated for tuberculosis that you are taking rifampicin.
Rating of rifampicin
Rifampicin is suitable for the treatment of tuberculosis – but only in combination with other antibiotics. Cases of rifampicin-resistant tuberculosis are increasing in a number of countries (particularly Russia, Myanmar, China and South Africa). Then other antibiotic combinations must be used.