This document discusses principles and guidelines for tuberculosis treatment. It outlines criteria for effective treatment, including disappearance of symptoms, cessation of bacterial excretion, regression of radiological abnormalities, and restored functionality. Treatment involves chemotherapy, surgery, and management of complications and comorbidities. Chemotherapy consists of intensive and continuation phases using multi-drug regimens based on drug sensitivity. Guidelines are provided for drug-resistant tuberculosis treatment using World Health Organization groups. Pathogenetic treatment and potential surgical interventions are also summarized.

1. Principles of tuberculosis treatment in modern
conditions. Anti-tuberculosis drugs. Drug-resistant
tuberculosis. Monitoring of treatment.

2. Criteria for the effectiveness of treatment of
tuberculosis patients
 disappearance of clinical and laboratory signs of
tuberculosis inflammation
 persistent cessation of bacterial excretion, confirmed
by microscopic and cultural studies
 regression of radiological manifestations of
tuberculosis (focal, infiltrative, destructive)
 restoration of functional capabilities and ability to
work

3. • Treatment of tuberculosis patients is carried out in
complex.
• It includes chemotherapy (etiotropic anti-tuberculosis
therapy) and surgical treatment, as well as pathogenetic
therapy and treatment of concomitant diseases.
• The content of treatment is determined by standards that
represent treatment regimens for certain groups of
patients, taking into account the form and phase of the
tuberculosis process.
• Within the standards, individualization of therapeutic
tactics is carried out taking into account the dynamics of
the disease, the drug sensitivity of the pathogen, the
pharmacokenetics of the drugs used and their interaction,
the tolerability of drugs and the presence of background
and concomitant diseases. This principle allows to
combine the standard of treatment of the disease and
individual tactics of treatment of the patient.

4. Basic principles of chemotherapy for tuberculosis
patients.
• Chemotherapy is the main component of the treatment of
tuberculosis and consists of drugs that suppress the reproduction of
MBT (bacteriostatic effect) or destroy them in the patient's body
(bacteriocidal effect).
• Chemotherapy should be started as early as possible after diagnosis
and be combined (polychemotherapy).
• The course of chemotherapy consists of two phases with different
tasks:
• The intensive therapy phase is aimed at eliminating the clinical
manifestations of the disease, maximizing the impact on the MBT
population in order to stop bacterial excretion and prevent the
development of drug resistance;
• The phase of continuation of therapy: aimed at suppressing the
remaining mycobacterial population, further reducing inflammatory
changes and involution of the tuberculosis process, as well as
restoring the functional capabilities of the patient.

5. According to the Order of the Minister of Health of the Republic
of Kazakhstan dated November 30, 2020 No.214/2020
Chemotherapy consists of 2 following phases:

 • the intensive phase is carried out in a hospital; when
the smear conversion is achieved, treatment continues
on an outpatient basis. Patients without bacterial
excretion are initially referred for treatment in
outpatient.
1
•the supportive phase is carried out in outpatient.
2

6. Treatment of patients with active tuberculosis with
preserved sensitivity:
• treatment is carried out with four anti-
tuberculosis drugs: isoniazid (H), rifampicin (R),
pyrazinamide (Z) and ethambutol (E);
• 2(4)RZ /4(7)HR
• Treatment of patients with active tuberculosis is
carried out with anti-tuberculosis drugs within
the guaranteed volume of free medical care.

7. Treatment of patients with drug-resistant tuberculosis is based on the use of
shortened and long-term treatment regimens with the use of anti-
tuberculosis drugs in accordance with the classification of the World Health
Organization, which is supplemented and changed as new drugs are
developed.
• fluoroquinolones (levofloxacin (Lfx) and moxifloxacin (Mfx)),
bedaquiline (Bdq) and linezolid (Lzd), which are highly
effective anti-tuberculosis drugs and, in the absence of
contraindications, are included in all cases of drug-resistant
tuberculosis
Group A:
• clofazimine (Cfz) and cycloserine (Cs) are the second
choice drugs for the treatment of drug-resistant
tuberculosis;
Group B:
• ethambutol (E), delamanide (Dlm), pyrazinamide (Z),
imipenem-cilastatin (Ipm-Cln) or meropenem (Mpm),
amikacin (Am) or streptomycin (S), ethionamide (Eto) or
protionamide (Pto), para-aminosalicylic acid (PAS), which are
used in in cases where it is impossible to select the required
number of effective drugs from groups A and B.
Group C:
Classification of anti-tuberculosis drugs recommended for the treatment of
resistant tuberculosis:

8. • The long-term treatment regimen includes at least five
effective anti-tuberculosis drugs from groups A and B.
• If it is impossible to draw up a treatment regimen with
the inclusion of the minimum number of effective anti-
tuberculosis drugs listed above, several drugs from
group C can be added so that the total number of
drugs is five to six.
• The duration of a long–term treatment regimen is 20
months, according to indications, it is extended to 24
months or more, taking medications daily 7 days a
week.
• The duration of a long-term treatment regimen in
children under 15 years of age with mild forms of the
disease is reduced to 9 months.

9. Types of Drug resistancy
Rifampicin resistance (RR): resistance to rifampicin detected using phenotypic or
genotypic methods, with or without resistance to other anti-TB drugs. It includes
any resistance to rifampicin, in the form of mono-resistance, poly-resistance,
MDR or XDR.

10. Basic principles of anti-tuberculosis
chemotherapy:1
1. Early start
2. Optimal duration
3. Continuity
4. The use of a combination of drugs taking into
account drug sensitivity
5. Direct control of treatment
6. Complex treatment

11. Pathogenetic treatment of tuberculosis
• anti-inflammatory
• desensitizing
• leveling side effects of anti-tuberculosis drugs
• stimulating healing processes
• Immunomodulatory
• Antioxidant
• Antihypoxant
• vitamin therapy.

12. Pathogenetic treatment of
tuberculosis
• Hormone therapy:
1.Steroid hormones (prednisone):
Indications:
- meningitis;
- pleurisy;
- polyserosit;
- bronchial lesion.
2.Aanabolic (nerobol, methylandrostenediol, etc.):
Indications:
- reduction of total blood protein;
- cachexia.

13. Pathogenetic treatment of
tuberculosis
• 3.leukopheron is a complex of natural interferons and other
cytokines of the immune response, normalizes the phagocytic
functions of macrophages and the activity of B–lymphocytes,
stimulates T-cell immunity (CD+). The form of release – ampoules of
10 thousand.ME interferon-a. It is prescribed intramuscularly,
intratracheal (ultrasound inhalation).
• 4. polyoxidonium is a high–molecular, physiologically active
compound. It has a pronounced immunomodulatory, antioxidant
and membrane stabilizing effect. The form of release is ampoules of
0.006 g., Administered 0.006 g. 2 times a week intramuscularly or in
the form of ultrasound inhalations. The course is 10-15 injections.
• 5. lycopide is a synthetic analogue of the cell wall components of all
bacteria, enhances the absorption and bacteriocidal function of
phagocytes. The form of release is tablets of 1 and 10 mg. The
treatment regimen is individual.

14. Pathogenetic treatment of
tuberculosis
• 6. pyrogenal – lipopolysaccharide isolated from a non-
pathogenic strain of Pseudomonas aeruginosa activates the
pituitary-adrenal and RES. Treatment in the 2nd phase from
25 MPD to 1000 MPD. The effect is the achievement of a
pyrogenic effect.Indications – destructive tuberculosis,
torpid course with a tendency to osumkovanie.
• 7.prodigiosan – lipopolysaccharide complex isolated from
the hepatogenic microbe Bac prodigiosum is indicated for
torpid processes in the lungs, cavity changes in them
without a pronounced inflammatory reaction and fibrosis.
• 8. Vitamin therapy – A, B-1, B-6, B-12, E, C, PP, D-2.

15. Pathogenetic treatment of
tuberculosis
• 9. laser and EHF therapy, ultrasound and inductothermythey
cause a reflex increase in lymph and blood circulation in the
lungs, contributing to the activation of reparative processes
due to increased inflammatory response and better
penetration of drugs into the lesion.
Contraindications:
-acute course of the tuberculous process in the lungs;
-extensive fibrous-cavernous and cirrhotic pulmonary tuberculosis;
-tendency to hemoptysis;
-combination with coronary heart disease, thyrotoxicosis, tumor
process.

16. Indications for surgical treatment:
- insufficient effectiveness of chemotherapy,
especially in case of multidrug resistance of
MBT;
- irreversible morphological changes caused by
the tuberculosis process;
- complications and consequences of
tuberculosis that threaten the patient's life,
have clinical manifestations or may lead to
undesirable consequences.

17. surgical treatment
lung resection and pneumonectomy;

18. surgical treatment types:
• lung resection and pneumonectomy;
• thoracoplasty;extrapleural filling;
• operations on the cavern (drainage, cavernotomy,
cavernoplasty);
• videothoracoscopic sanitation of the pleural
cavity;thoracotomy;
• pleurectomy, lung decortication;removal of intra-thoracic
lymph nodes;
• bronchial surgery (occlusion, resection and plastic surgery,
stump reamputation);
• destruction of pleural junctions for correction of artificial
pneumothorax.

19. Complications of surgical treatment
• Pulmonary hemorrhage;
• Spontaneous pneumothorax and
pyopneumothorax;
• Nodulobronchial fistula;
• Cicatricial stenosis of the main or lobar bronchus;
• Bronchiectasis with suppuration;
• Bronchiolitis (formation of a stone in bronze);
• Pneumofibrosis with hemoptysis;
• Carapace pleurisy or pericarditis with impaired
respiratory and circulatory functions.