For the most common form of TB, an effective drug treatment in the form of a combination therapy of multiple antibiotics has existed for quite some time. Unfortunately, through the careless use of these antibiotics drug resistance developed that provoked sharper controlled treatment methods, demanded the use of less tolerable drugs and required longer treatment times.
Anti-TB treatment generally involves antibiotics that were specifically developed to be effective against the various TB pathogens. To avoid the development of drug-resistance and relapses, a combination of these drugs need to be taken over a period of 6-8 months (i.e., for much longer than the symptoms may last). Furthermore, the drugs have to be administered as specified by the WHO under DOTS (Directly Observed Therapy Short-course). This means that during the first two to three months of treatment patients must take each dose under the supervision of a physician or registered healthcare professional. For the remaining months, directly observed treatment administration has to occur on a weekly or monthly basis.
To prevent the potential situation that the patient may run out of medicine midway through treatment because insufficient drugs were purchased by the state (also known as a stock-out), some countries such as in India have introduced patient-wise boxes (see left). These packages contain enough medication for the full treatment of a TB patient to avoid the risk of discontinuation of treatment and the risk of development of drug resistance.
For drug-resistant TB newer (and more expensive) antibiotics, the so-called “second-line antibiotics” are used. However, a longer treatment period (18-24 months) is required and severe side effects (loss of hearing, depression, etc) may surface. In addition, patients have a significantly lower chance of full recovery. For victims of XDR-TB, oftentimes doctors can do little more than treat the symptoms instead of the disease itself, and there is very little chance of survival.
In the next section we focus on the epidemiology and the global dimensions of the disease, as well as the direct and indirect economic damages that tuberculosis causes worldwide each year.