Drug treatment of endometrial tuberculosis

Endometrial tuberculosis often follows pulmonary tuberculosis, renal tuberculosis, gastrointestinal tuberculosis, bone or joint tuberculosis, etc., and occasionally can be part of systemic miliary tuberculosis. When tuberculosis bacteria infect the body, they generally do not develop the disease immediately, but go through a period of incubation. During the incubation period, when the body is in a state of poor resistance, tuberculosis bacteria can invade the endometrium and eventually affect the basal layer of the endometrium. So, what are the drug treatments for endometrial tuberculosis?

Drug treatment The use of anti-tuberculosis drugs is an important measure to treat tuberculosis.

(1) Commonly used anti-tuberculosis drugs: Ideal anti-tuberculosis drugs have bactericidal, sterilizing or strong antibacterial effects, low toxicity, few adverse reactions, are not prone to produce drug-resistant strains, are inexpensive, easy to use, and have sufficient supply. After oral or injection, the drug can reach an effective concentration in the blood and can penetrate into phagocytes, the peritoneal cavity or cerebrospinal fluid, with rapid and long-lasting efficacy.

Currently, commonly used anti-tuberculosis drugs are divided into 4 categories:

① Those with similar efficacy against intracellular and extracellular bacteria, such as rifampicin, isoniazid, ethionamide and cycloserine;

② Those with a dominant extracellular effect, such as streptomycin, kanamycin, capreomycin and puromycin;

③ Those with dominant intracellular effects, such as pyrazinamide;

④ Antibacterial drugs, such as sodium p-aminosalicylate, ethambutol and thiosemicarbazide.

Streptomycin, isoniazid and sodium para-aminosalicylate are called first-line drugs; other drugs are called second-line drugs. In clinical practice, first-line drugs are generally used first. When first-line drugs produce resistant strains or patients cannot tolerate them due to toxic reactions, 1 to 2 second-line drugs can be used instead.

(2) Chemotherapy regimen: Understanding the mechanism of action of anti-tuberculosis drugs and considering their side effects are important bases for selecting a combination chemotherapy regimen.

① Long-term standard chemotherapy: triple therapy with streptomycin (SM), isoniazid (INH) and sodium para-aminosalicylate (PAS) for 1.5 to 2 years. The cure standard is that the lesion is absorbed and stable without recurrence. However, due to the long course of treatment, some patients no longer adhere to regular medication due to the disappearance of symptoms, resulting in incomplete treatment, which is often the cause of drug-resistant mutant strains. The treatment plan is to use streptomycin (SM), isoniazid (INH) and sodium para-aminosalicylate (PAS) every day for the first 2 months, and then use isoniazid (INH) and sodium para-aminosalicylate (PAS) (2SHP/10HP) for 10 months, or streptomycin (SM), isoniazid (INH) and sodium para-aminosalicylate (PAS) for 2 months, use streptomycin (SM) twice a week, isoniazid (INH) and sodium para-aminosalicylate (PAS) every day for 3 months, and use isoniazid (INH) and sodium para-aminosalicylate (PAS) (2SHP/3S2HP/7HP) for 7 months.

② Short-term regimen: Since the 1970s, domestic and foreign scholars have studied short-term regimens of anti-tuberculosis drugs and compared them with long-term standard regimens, proving that reducing the duration and dosage of medication can also achieve a cure. In recent years, there has been a tendency to favor short-term chemotherapy regimens to achieve high efficacy, low toxicity and low price.