360 Where There Is No Doctor 2011 Green Pages
Recommended treatments
Always check with the health authorities in your
region to find out what combinations of medicines
are recommended in your area. If you cannot get
information from them, use one of the following
combinations:
1. For new cases of TB, give isoniazid, rifampicin,
ethambutol, and pyrazinamide for 2 months.
Doses should be taken every day. Then stop
taking pyrazinamide and ethambutol, but
continue using rifampicin and isoniazid for
another 4 months.
2. For areas where drug resistance to isoniazid
is developing, or if the person has HIV,
give isoniazid, rifampicin, ethambutol, and
pyrazinamide for 2 months. Then stop taking
pyrazinamide, but continue using rifampicin,
isoniazid, and ethambutol for another 4 months.
All doses should be taken every day.
3. If the person has used TB medicines in the past
but gets sick again, give isoniazid, rifampicin,
ethambutol, pyrazinamide and streptomycin
for 2 months. Then give isoniazid, rifampicin,
ethambutol, and pyrazinamide for 1 month.
Then continue using rifampicin, isoniazid, and
ethambutol for another 5 months. All doses
should be taken every day.
4. Pregnant women with TB should seek
experienced medical advice. Otherwise use
the combination of medicines in number 1
(without pyrazinamide) or in number 2. Never
use streptomycin during pregnancy. Also give
50 mg. of vitamin B6 (pyridoxine) every day.
Isoniazid (INH)
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Often comes in: tablets of 100 or 300 mg.
This is the most basic anti-TB medicine. To treat
TB, it must always be given with rifampicin and
at least 1 other anti-TB medicine. For prevention
it can be given alone. Resistance to isoniazid is
beginning to develop in some areas.
Risks and Precautions:
Rarely, isoniazid causes anemia, nerve pains
in the hands and feet, muscle twitching, or even
seizures, especially in malnourished persons.
These side effects can usually be treated by giving
50 mg. of pyridoxine (vitamin B6) daily, by mouth
(p. 393).
Sometimes isoniazid can damage the liver.
Persons who develop the signs of hepatitis (yellow
color of skin and eyes, itching, loss of appetite,
pain in the belly, see p. 172) while taking isoniazid
should stop taking the medicine.
Dosage for isoniazid (5 mg./kg./day for adults;
10 mg./kg./day for children): using tablets of 100 mg.
Give isoniazid once a day.
In each dose give:
adults: 300 mg. (3 tablets)
children: 50 mg. (½ tablet) for each 5 kg.
the child weighs.
For children with severe TB, or persons with
tubercular meningitis, double the above dose until
improvement takes place.
For prevention of TB in family members of
persons with TB, and for persons with HIV, it is
recommended to give the above dose of INH for 6
months to 3 years.
Rifampicin
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Often comes in: tablets or capsules of 150 or 300 mg.
This antibiotic is powerful in fighting TB. It is
never taken alone or the TB will become resistant
to it. When combined with isoniazid and at least
one other TB medicine, it can shorten treatment by
several months.
(Rifampicin is also used to treat leprosy—see
p. 363.)
It is important to keep taking rifampicin regularly,
without interruption. Be sure to get more before
your supply runs out.
Risks and Precautions:
Rifampicin can cause serious damage to
the liver. A person who has liver problems or is
pregnant should take this medicine under medical
supervision.
Side effects: Urine, tears, feces (shit), saliva,
mucus from coughing (sputum), and sweat are
colored red-orange by rifampicin. Rarely, rifampicin
can cause fever, loss or increase of appetite,
vomiting, nausea, confusion, skin rash, and
menstrual problems.
Rifampicin reduces the effectiveness of oral
contraceptives. So women taking birth control pills
should get medical advice about increasing the
dose. Or, use another method such as condoms,
IUD, or a diaphragm while taking this medicine.