Fundamental principles of therapy
Managing a child with a specific infectious process is the task of a pediatric phthisiotherapist. However, the disease requires a multidisciplinary approach: when various organs are affected, subspecialists (neurologist, orthopedist, nephrologist, ophthalmologist) must be involved in the treatment.
Therapy must be comprehensive. It includes targeting the pathogen itself (etiotropic treatment), eliminating the mechanisms of disease development (pathogenetic), surgical intervention (indicated by clinical guidelines), and mandatory correction of concomitant diseases. Great attention is paid to the daily regimen, strict dosing of physical activity, and nutrition, which is selected taking into account the patient's age and the activity of the infection.
The recovery process always takes a long time (from six months to a year and a half) and is divided into three consecutive stages:
- Hospital. The intensive phase of treatment is carried out.
- Sanatorium. The continuation phase of therapy and rehabilitation begins.
- Tuberculosis Dispensary. Outpatient follow-up care and dispensary observation are carried out.
Specific Chemotherapy
The main rule of etiotropic treatment is the immediate start of therapy as soon as the diagnosis is verified. To prevent mycobacteria from developing resistance, a combination regimen is always used: the patient is prescribed two or more antibacterial drugs simultaneously.
Medications are divided into two main groups:
- First-line drugs (main). Treatment is initiated with these drugs. This group includes: isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin.
- Second-line drugs (reserve). Used only in cases of proven resistance of the pathogen to the main agents. These include: prothionamide, aminoglycosides (kanamycin, amikacin), polypeptides (capreomycin), cycloserine, rifabutin, aminosalicylic acid (PAS), and fluoroquinolones (e.g., lomefloxacin).
Vaccine Prophylaxis
Preventive measures pursue two global goals: to prevent the very fact of a child's infection and to prevent the development of severe, generalized forms of the disease.
Specific prevention is carried out using the BCG vaccine. The key rule of neonatal vaccination is that the drug is administered strictly intradermally. If the technique is followed correctly, a characteristic papule forms at the injection site, often called a "orange peel" sign.
The development of specific inflammation at the injection site is a normal, natural stage in the formation of the immune response. Visually, this looks like a papule, in the center of which an area of local tissue necrosis may form — this is not a pathology.
Prognosis and Risk Factors
The infectious process itself is characterized by a prolonged, wave-like course, in which periods of exacerbation alternate with remission. Disease outcomes are highly variable. The prognosis directly depends on the clinical form, the initial state of immunity (premorbide background), the patient's age, and how timely the diagnosis was made and adequate therapy was prescribed.
In pediatrics, two critical periods are distinguished when the risk of adverse outcomes and disability is maximal:
- Early childhood (the reason lies in the physiological immaturity of the immune system).
- Pubertal period (the risk factor is large-scale hormonal restructuring of the body).
Mycobacterium tuberculosis (MTB) has extremely high resistance to environmental factors. This allows it to maintain its infectious potential outside the human body for a long time. For a reliable (pathognomonic) confirmation of the diagnosis, bacteriological confirmation is necessary — the isolation of MTB from the patient's biological fluids (most often from sputum).
To memorize the main first-line drugs, you can use the acronym PIRSE: Pyrazinamide, Isoniazid, Rifampicin, Streptomycin, Ethambutol.
Class and exam questions
Which sign is absolutely reliable for making a diagnosis?
A pathognomonic criterion for tuberculosis is considered to be bacteriological confirmation, that is, the isolation of the mycobacterium itself from biological fluids, for example, from sputum.
Why is a combination of drugs always prescribed for tuberculosis?
The simultaneous use of two or more drugs is necessary to prevent the development of resistance of the mycobacterium to treatment.
Which clinical form of tuberculosis is most common in children?
The dominant form in childhood is tuberculosis of the intrathoracic lymph nodes (TITLN).
What else to study on this topic
- Mechanisms of drug resistance development in mycobacteria
- Features of tuberculosis of the intrathoracic lymph nodes (TITLN)
- Indications for prescribing second-line drugs
- Surgical treatment of the specific process in children
- Pathogenetic therapy and correction of concomitant pathologies
Master the entire topic in the Pediatrics course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Treatment and prevention of tuberculosis in children" and 3,738 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 71 video lessons on the subject
Other topics from the section «Chapter 12. Infectious and parasitic diseases»
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