INDICES> Treating pulmonary TB

[George Kibumba <did.jms@imul.com>]

INDICES> Treating pulmonary TB
-------------------------------------------

I have a major and timely worry because we have a lot of pulmonary
tuberculosis.

There is a recommendation I read from WHO (World Health Organisation),
that
you can give ethambutol (E) and isoniazid (H) for six months during
the
continuation phase -- of the conventional PTB (Pulmonary Tuberculosis)
management protocol.

However, all the cases I have handled fair well during the first 2
months
of rifampicin (R), isoniazid (H), pyrazinamide (P) and ethambutol (E).
When medical doctors switch them to E and H, they develop a choking
breath
and some start complaining of TB symptoms: commonly cough.  I always
make
sure that they are put on R and H, and they dramatically respond.
Is it possible for you to correctly investigate this before too late?

Also, there is this DOTS (Directly Observed Treatment Short Course)
idea.
A Pharmaceutical Press Publication, Pathology and Therapeutics for
Pharmacists, A basis for clinical pharmacy practice, 2nd edition,
2000, by
Russell J Greene and Norman D Harris, Page 279 says about DOTS,

"...many patients have limited comprehension or understanding of the
need
for strict compliance and may have an unstable lifestyle.  The
response to
this has been the initiation of directly observed therapy (DOT) to
ensure
compliance.  .... One small study has shown that more patients who are
well-counselled are more likely to comply if they are self-medicating
than
those in a DOT programme.  The problem still remains of tracing
dropouts
who donot have a fixed address."

Notice from this extract that interventions to health problems in our
countries seek to address symptoms, rather than the causes.  The cause
of
all our problems are poor health systems and WHO must concomitantly
address this.
Otherwise, we might lose drugs for tuberculosis, the way we have lost
chloroquine for malaria.

Sincerely,

George Kibumba, MPS
COMMUNITY AND Drug Information Pharmacist
Drug Information Desk,
Joint Medical Store,
P.O.BOX 4501, KAMPALA, Uganda(E.A)
Official address: did.jms@imul.com
Personal address: kibumba@yahoo.com
Mobile: 071 81 54 28
Tel:    256-41-268482
fax:    256-41-267298


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