Tuberculosis is a global health problem that requires special attention. It is estimated that one third of the world's population has been infected with tuberculosis germs. According to WHO, every second one person is infected with TB in the world. Indonesia itself ranks second as the country with the most TB cases after India. The total number of TB cases in Indonesia per year is 351,893. WHO even estimates that 583,000 new cases of TB occur every year in Indonesia. In fact, TB treatment is fairly simple - with a combination of prescription antibiotics.
However, one of the reasons why new cases of TB continue to appear and many that are not successfully cured are treatment failure. Because, TB treatment can take up to 6 to 9 months so that it is at high risk to forget to take medication or even cut off halfway. In some cases, TB treatment can even run for years.
Treatment of TB in Indonesia
The success rate of treatment for all tuberculosis cases in Indonesia in 2016 was 85%, falling from 2014 which reached 87 percent. In fact, the Ministry of Health sets a minimum standard for treatment success rates of 90 percent.
In Indonesia, TB treatment consists of 2 stages, namely the initial (intensive) and the advanced stages. In the early stage, people with TB who undergo routine treatment will no longer be contagious within a period of two weeks. Two months after initial treatment, sputum containing live TB germs (positive smear) will turn negative.
Negative smear can still have a risk of transmission, but is much smaller than positive smear. In people with TB who experience resistance, the chance of turning from positive smear to negative is only about 50% and the cure rate is only 65%.
Whereas in the advanced stage , the amount and dose of the drug given will decrease, but the duration of treatment lasts longer. This stage is important to get rid of resistant germs so that there is no recurrence or resistance.
Why does TB treatment take a long time?
The bacteria that cause tuberculosis, M. tuberculosis, are types of bacteria that are resistant to acid. Once inside the body, these bacteria can "fall asleep" long ago in the "dormant" phase - they remain in the body, but are not actively reproducing. In fact, most antibiotics actually function when bacteria are in the active phase. This dormant phase is thought to make bacteria resistant to the effects of antibiotic drugs (antibiotic resistant).
Indeed, most bacteria that cause TB will die when treatment goes on in the eighth week, but some bacteria that are still "asleep" and already resistant to the drug still need further treatment. If left untreated, the chances of your TB disease can recur, coupled with the risk of germs attacking it becoming increasingly resistant to drugs.
Therefore, TB treatment requires a long time with a combination of several types of antibiotics that have different ways of working. The aim is to kill active bacteria as well as those who are still "asleep" and those who are already resistant.
Antibiotic resistance can prolong treatment time
The bacteria are said to be resistant when they are immune and not affected by TB treatment. The bacteria that cause TB are generally resistant to two types of TB drugs, namely rifampicin and isoniazid with or without other antituberculosis drugs referred to as MDR-TB (multidrug resistance-Tuberculosis).
In more severe conditions, germs are not only resistant to the first-line TB treatment, but also to the second line, which is referred to as XDR-TB (Extensive Drug Resistant-Tuberculosis).
Resistance can be caused by interrupted treatment, messy medication schedules, and more. As a result, TB treatment becomes very difficult to be effective so it requires a longer time - at least 12 months, even up to 24 months.
The main priority for dealing with drug resistance is preventing it before it occurs through proper and regular TB treatment, and good supervision.
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