Pills, pills, and more pills

4 08 2010

So, my first week has wrapped up and I have to say I learned quite a lot. My first day was pretty interesting. After getting lost on the one of many confusingly named North Carolina highways, I managed to get to Wake County Human Services around 8 am.  I joined Rosemary, one of the DOT nurses, on her busy day of visiting the homes of TB patients. It was fairly interesting- and the patients we visited were very diverse. They were of all ages, nationalities, and socioeconomic backgrounds. The daily routine consists of visiting patients at their homes or workplaces, and asking if they are suffering any side effects while delivering their medications. I say medication(s) because most patients must be on multiple regimens. There are four commonly prescribed drugs for TB: isoniazid, rifampin, ethambutol, and pyrazinamide. TB, like any infectious disease, can be not-so-straightforward in terms of treatment due to the potential of resistance. Many patients can have multi-drug resistant (MDR) TB infection…which can be difficult (but not impossible) to treat. The next class of TB is XDR (extensively drug resistant) TB…and like the name suggests is incredibly difficult to medicate. It is important for patients to not only take the medicine continuously to get better, but also to minimize the risk that their strain of TB they have will not end up being resistant.  

Unfortunately this is all easier said than done.

While the medications are provided for free for those who need it and can be delivered to homes, compliance is still a very serious issue for several reasons. One of the main reasons is the sheer number of pills patients have to take…they can reach more than 10 pills per day. Also, these pills can taste horrible and cause side effects such as nausea and vomiting. Many adults have trouble keeping the pills down…so you can imagine how kids under five who have been exposed to TB struggle to take the medicines. TB can’t be treated like most bacterial diseases in a short amount of time. Active TB requires at least 26 weeks of treatment. Latent TB is usually treated with an optional preventative regimen of isoniazid for at least 9 months. Also…for those of you on the college mindset…I should mention that alcohol consumption is prohibited during these 9 months of treatment. Hearing patients’ many complaints about their medication and listening to kids scream and cry whenever they taste the medicine makes the drug compliance issue all-the-more tangible.

These DOT visits made it more clear to me why TB should not be forgotten in the US. The population dynamics are constantly changing, with immigrants, refugees, and foreign travelers constantly entering and leaving the country. Also, it takes only one exposure event to put a person at risk for acquiring the tuberculosis bacterium. I definitely enjoyed visiting the patients and hearing their stories…and I am excited to find out what happens next week.

– Melanie Subramanian

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