Medicine for tuberculosis: what it is and how it works

The 4-in-1 medicine for tuberculosis is an antibiotic that contains a combination of 4 substances, such as rifampicin, isoniazid, pyrazinamide and ethambutol, indicated for the treatment of the intensive initial phase of pulmonary and extrapulmonary tuberculosis.

This remedy works by promoting the elimination of bacteria Mycobacterium tuberculosiswhich can enter the body and promote inflammation of the lungs or other parts of the body.

Rifampicin, isoniazid, pyrazinamide and ethambutol are offered free of charge by the SUS and should be used according to the guidance of the pulmonologist or infectious disease specialist, even if symptoms are no longer noticed. See more details on tuberculosis treatment.

What is it for

The 4-in-1 remedy is indicated for the treatment of pulmonary tuberculosis or extrapulmonary tuberculosis that affects other organs, such as the membrane that covers the lungs, lymph nodes, skin, genitourinary system, joints, bones and meninges in the brain.

How it works

The medicine for the treatment of tuberculosis has in its composition a combination of 4 antibiotics that act by promoting the fight and elimination of the bacteria responsible for tuberculosis, the Mycobacterium tuberculosisalso known as Koch’s bacillus.

The substances present in this medicine are:

• Rifampicin: inhibits the mycobacterial RNA polymerase enzyme, preventing its multiplication;
• Isoniazid: actively kills mycobacteria in infected cells;
• Pirazinamida: the exact mechanism of action is not fully known, but it is known that it acts by reducing the pH of the cellular environment, which hinders the growth of mycobacteria;
• Ethambutol: interferes with the metabolism of the mycobacteria, which inhibits its multiplication, leading to the death of the mycobacteria.

This association is generally only necessary in the initial phase of treatment, which is the first 2 months, this phase being called intensive.

Then, the maintenance phase begins, in which only rifampicin and isoniazid are normally indicated in doses that vary according to the person’s age and weight and the severity of the disease. See how to take rifampicin and isoniazid.

How to drink

Rifampicin, isoniazid, pyrazinamide and ethambutol tablets should be taken every day, in a single dose, with a little water, preferably 30 minutes before or 2 hours after a meal, for 2 months of treatment, according to the guidance of the doctor.

The number of tablets used in each dose for adults varies according to body weight, and is normally indicated:

For children weighing between 20 and 30 kg, the recommended daily dose is 2 tablets in a single dose. Children and adolescents weighing less than 20 kg should not take this medicine.

If a dose is forgotten, the person should take the forgotten pills as soon as they remember, unless they are close to taking the next dose. In these cases, the missed dose should be skipped.

It is necessary to take the medicine regularly and never stop treatment on your own, as bacterial resistance may develop. Understand what bacterial resistance is and how to avoid it.

Possible side effects

The most common side effects that may occur during treatment with this medication are peripheral neuropathy, diarrhea, abdominal pain, nausea, anorexia, vomiting and liver toxicity.

In addition, increased uric acid may also occur, especially in patients with gout, reddish color of body fluids and secretions, joint pain, redness, itching and rash, visual changes and menstrual cycle disorders.

Who shouldn’t use

This medication should not be used by people with allergies to any of the components of the formula, people with liver disease or a history of jaundice and changes in blood levels of liver enzymes caused by anti-tuberculous medications in the past.

Furthermore, it should also not be used in people with vision loss due to optic nerve disorder. If your doctor recommends it, this medicine can be used in pregnant women.

The doctor must be informed about any medication the person is using, including contraceptive pills, as this medicine for tuberculosis can reduce its effectiveness.