Also as a lung disease, the course of treatment for pneumonia is about one week, while for tuberculosis it is at least six months. Such a long course of treatment may seem unsatisfactory, but for tuberculosis, the current regimen is a contribution brought to humanity by generations of scientists with inspiration, sweat, sacrifice, and dedication. I. History of chemotherapy for tuberculosis – from monotherapy to an 18-month course In 1882, Robert Koch discovered that the tubercle bacillus was the main cause of tuberculosis. Before Robert Koch discovered the tuberculosis bacterium as the culprit of tuberculosis, tuberculosis patients relied on their body’s resistance to fight the disease mainly through rest, sunlight, and nutrition. The discovery of Mycobacterium tuberculosis led to a shift from passive defense to active offense, as scientists designed chemically synthesized drugs to destroy the structure of the bacterium, and the treatment of tuberculosis entered the era of chemotherapy. The world’s first anti-tuberculosis drug, streptomycin, was introduced in 1943 and was used to treat patients after a phenomenon was observed: patients on streptomycin had a significantly lower mortality rate at 6 months of treatment compared to patients on bed rest, but after 5 years the mortality rate was comparable to that of patients on bed rest. Why is an effective drug “ineffective” after a longer period of observation? Scientists have found that the use of streptomycin eliminates a large number of tuberculosis bacteria early on in the course of the drug’s initial use, showing a reduction in the patient’s condition. But then the bacteria became resistant to the drug under the pressure of the drug, and the drug became ineffective, eventually leading to treatment failure. As a result, scientists recognized that the combination of multiple drugs should be the basic principle of anti-tuberculosis treatment to avoid drug resistance caused by monotherapy. Later, other anti-tuberculosis drugs emerged one after another, and by the 1960s, a combination of isoniazid, streptomycin and para-aminosalicylic acid was developed, and tuberculosis was no longer an incurable disease. In the 1970s, Chinese tuberculosis researchers proposed five basic principles of tuberculosis treatment: early treatment, regular dosing, drug combination, appropriate dosage, and complete treatment, with the fundamental aim of avoiding drug resistance and reducing disease recurrence, which remain the basic principles of tuberculosis chemotherapy to this day. However, isoniazid, streptomycin and para-aminosalicylic acid regimens also had shortcomings: the course of treatment was as long as 18 months, streptomycin required intramuscular injections that were not easily adhered to by patients, and nearly half of the patients interrupted treatment due to adverse drug reactions or the inconvenience of using the drugs. By 1979, the prevalence of tuberculosis in China was still as high as 837 per 100,000, and in some provinces the prevalence of tuberculosis even exceeded 1000 per 100,000. Based on the characteristics of TB bacilli multiplying in the body and the different characteristics of drugs, they proposed a combination regimen using isoniazid, rifampin, pyrazinamide and ethambutol. If the anti-tuberculosis drugs are compared to an army attacking the tuberculosis bacteria, then isoniazid and rifampin are the artillery, which can rapidly and heavily destroy the actively growing tuberculosis bacteria and reduce the infectiousness of patients; while rifampin and pyrazinamide are the snipers, which destroy the slow-growing and occasional multiplying bacteria and reduce the possibility of relapse of patients; ethambutol is the guerrilla team fighting with the regular army, although the combat power is not very strong Although not very strong, it reduces the incidence of drug resistance by working in concert. This regimen is also the most rational and effective anti-tuberculosis treatment to date, with a cure rate of more than 95%, not only shortening the course of treatment to 6 months, but also, all drugs can be taken orally, making it easy for patients to administer. During the same period, researchers in the United Kingdom, Hong Kong and other countries or regions have also reached similar conclusions. Because of the short course of short course chemotherapy, good efficacy and convenience of drug administration, it is possible to carry out the treatment at the grassroots level where the basic conditions are weak, and it has become an epoch-making progress in chemotherapy for tuberculosis. After the success of the short-course chemotherapy program, it was expanded in some areas of the country. The prevalence of smear-positive cases in areas where short-course chemotherapy was implemented decreased by 44.4% in 10 years, while the rate in areas where short-course chemotherapy was not implemented decreased by only 12.3%, showing the great contribution of short-course chemotherapy to tuberculosis control. After 2000, a modern TB control strategy centered on short-course chemotherapy was fully implemented in China. The great success of short-course chemotherapy also suggests to patients that most patients can be cured with standardized treatment. Despite the remarkable effect of antituberculosis chemotherapy, some patients have misconceptions about chemotherapy, and the common ones are as follows: 1, the whole drug cannot be used, and premature discontinuation causes treatment failure or relapse. Some patients stop taking the drug prematurely due to symptom reduction, and some patients use so-called more advanced methods to try to cure TB in the short term. However, tuberculosis bacteria are a “tricky” bacteria, showing various growth states such as fast, slow and stationary, among which the slow-growing bacteria are difficult to be completely eliminated by drugs. Even if the symptoms disappear completely and the lung shadows are completely absorbed, the tuberculosis treatment program should be no less than six months for tuberculosis, no less than twelve months for tuberculous meningitis, and more than twenty months for multidrug-resistant tuberculosis. 2. It is considered that the lungs still have shadows after the course of treatment is not yet cured. A considerable number of patients with tuberculosis have had lung lesions for a long time at the time of consultation, as evidenced by the coexistence of “new” and “old” lesions on the chest radiograph. The “new” lesions can be fully or mostly absorbed after active treatment, while most of the “old” lesions cannot be absorbed. Therefore, in most patients, after clinical cure, some scar tissue remains in the lungs, which is an “irreversible” change that never disappears. Even in cured TB patients, there may still be shadows in the lungs after treatment, but they do not affect work and life in the future. 3.The use of traditional Chinese medicine or so-called prescriptions due to the fear of side effects of anti-tuberculosis drugs. Although Chinese medicine is a precious treasure bequeathed to us by our ancestors, unfortunately, there is no substitute for chemotherapy in the treatment of tuberculosis, and no so-called prescription anti-tuberculosis treatment has been rigorously tested for its effectiveness. Like all drugs, anti-tuberculosis drugs also have adverse drug reactions, drug-related liver damage is common, specifically manifested as abdominal distension, decreased appetite, nausea, and elevated transaminases or bilirubin can be found in laboratory tests. 4, after the cure of tuberculosis still worried, too worried about the recurrence of the disease. It is undeniable that a very small number of patients have a relapse of tuberculosis in their subsequent lives after being cured, but there is no need to worry too much. First of all, the current anti-tuberculosis treatment course of up to six months has fully taken into account the possible relapse of tuberculosis, and a full course of treatment can minimize the possibility of relapse; secondly, 90% of relapses occur in the first year of drug withdrawal, and the possibility of long-term relapse after standardized treatment is very low. Therefore, patients should have regular checkups at the hospital during the first year of drug discontinuation, and after one year of continuous observation, they can work and live normally. Over the past three decades, with the spread of short-course chemotherapy for tuberculosis, the prevalence of infectious tuberculosis in China has dropped by three-quarters, and the death rate from tuberculosis has dropped by more than four-fifths. The efforts of China in TB control should be considered a model for the world to follow,” said Hiro Nakajima, director general of the World Health Organization. Scientists are currently working on shorter courses of anti-tuberculosis regimens. It is expected that in the near future, a cure for this long-standing human health hazard can be achieved in a shorter period of time.