Source: www.theguardian.com
As you browse the newspaper recently, I am sure many are alarmed by the staggering tuberculosis (TB) health statistics reported by the Health Minister, Datuk Seri Dr S. Subramaniam. Tuberculosis is the second most contagious disease after HIV/ AIDS worldwide. Last year in 2013 alone, 24,071 TB cases were reported with 1,597 death cases from TB. In comparison to 2012, TB cases had increased in 2013 by a staggering 6% and a 13% in mortality from the disease. In 2012, 22,710 TB cases were reported with deaths amounting to as many as 1,414 cases.
The increase in cases could be due to the increase in number of foreigners in the country, where proper screening and detection of foreigners is warranted. From the total of cases reported in 2013, 13% were contributed by foreigners and 86% were Malaysians. To date, Sabah accounts for the highest number of TB reported cases followed by Selangor, Sarawak and Johor. If no proper measures are being taken, one patient may infect as many as ten people in the community! It is important to practice caution in the high risk group of being infected by TB such as in children, HIV positive patients, elderly, diabetics and those with low immune system.
So far, awareness with campaigns and promotions on TB has been done nationwide. Awareness on the disease helps shed some light on TB disease which is sometimes associated to a stigma in the country igniting fear amongst the community to be fearful of TB patients. The prevention of disease is done by the Bacillus Calmette- Guerin/ BCG vaccination to protect neonates from severe TB forms. What else can be done? TB management should be tackled by the root of its problem whereby patients receiving treatment should be clearly explained and counselled by doctors/ pharmacists/ healthcare educators on:
- The role and function of their anti-TB medication;
- Their DOTS (Directly Observed Therapy, Short-course) therapies of anti-TB drugs and compliance reinforcement; and
- The side effects of their medication.
The role and function of their anti-TB medication
Using layman terms, patient should be informed about their intensive therapy (conventional combination of anti-TB drugs or individual treatment of ethambutol, pyrazinamide, isoniazid and rifampicin as well as pyridoxine) and maintenance (isoniazid and rifampicin) therapy. The importance of completion of therapy must also be stressed.
DOTS therapies function of their anti-TB medication and compliance reinforcement
Healthcare professionals should play their role by re-emphasizing the Directly Observed Therapy, Short-course (DOTS) therapy which involves observing patients as they take their medication. It is not uncommon that some patients get discharged from TB clinics and hospitals with medications but do not follow up with DOTS in nearby clinics. Thereon, they may default their follow-up and promote multi drug resistance in TB therapy. Compliance to the anti-TB medication must be enforced. The intensive phase for conventional anti-TB last for 2 months followed by a maintenance phase of 4 months. By understanding how completing this medication could radically eradicate anti-TB, patients may be more willing to comply with therapy completion.
Side effects of the medication
Last but not least, the side effects of the medication should be made clear to patients so that they know what to anticipate. This also allows patients to be more aware about their medication. For all we know, some patients may have defaulted their therapies after they have noticed they had orange or red urine or tears which they may mistaken as bleeding, when in fact it is merely a common side effect to the drug rifampicin. The other common side effects to the conventional anti-TB drugs are listed in the table below.
We should all come to terms on some implications as a result of drug non- compliance. The hefty price to pay includes further spread of drug-resistant tuberculosis, more people in the community being exposed and subject to infections of TB and needless to say, more funds required by Ministry of Health to tackle this problem. To conclude, everyone needs to play their role to improve the spread of TB whether it involves protecting yourselves with face masks, limiting contact with TB patients during their infectious period, spreading awareness on the disease or providing necessary counselling and support to TB infected patients.
Ms Tan Li Yin is a clinical pharmacist working in Selangor. She believes in the importance of patient education.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
References:
- Sivanandam H, The star online, “Subra: One patient can potentially infect 10 people.” April 1, 2014. http://www.thestar.com.my/News/Nation/2014/04/01/24071-TB-cases-reported-last-year-Subra-One-patient-can-potentially-infect-10-people/
- Cruez AF, The sundaily online, “TB second highest contagious disease.” 31 March, 2014. http://www.thesundaily.my/news/1002906
- Malaysia National Clinical Practice Guideline Management of tuberculosis (3rd edition) , MOH/P/PAK/258.12(GU),Nov 2012
- Hospital Selayang Drug formulary 1st edition, 2012. X. TB regimen. pp. 241-242