Tuberculosis (TB) is an important public health issue everywhere in the world. It is caused by Mycobacterium tuberculosis and must be treated for a long time under strict supervision for total cure to avoid drug resistance. Both must be treated, but it is very important to recognize the difference in order to treat it effectively.
Anti-Tubercular Drugs
Anti-tubercular drugs are classified into first-line and second-line drugs based on their strength, toxicity, and administration phase.
The first-line agents are the foundation of standard TB therapy. Isoniazid kills actively growing bacilli by inhibiting the production of mycolic acid. Rifampicin stops RNA synthesis, thus bacterial growth. Ethambutol stops cell wall formation, and streptomycin, which is an aminoglycoside, stops protein synthesis.
Second-line drugs are employed in the event of multidrug-resistant TB (MDR-TB) or intolerance to first-line drugs. They are represented by fluoroquinolones such as levofloxacin and moxifloxacin, injectable drugs such as amikacin and capreomycin, and others such as cycloserine, ethionamide, and linezolid.
A typical drug-susceptible TB treatment involves two months of intensive phase with isoniazid, rifampicin, pyrazinamide, and ethambutol, followed by a four-month continuation phase with isoniazid and rifampicin.
Regular follow-up of treatment is necessary to avoid drug resistance or relapse. The patient must also be checked for side effects, including liver damage (due to INH, RIF, or PZA), eye disease (due to EMB), and deafness (due to streptomycin). Rifampicin also interferes with the metabolism of a large number of drugs through the induction of their breakdown in the liver.
How to Tell if Balanitis has Fungal or Bacterial
Balanitis refers to inflammation of the glans penis and can be associated with redness, swelling, pain, and discharge. The most common infectious causes are fungal infection and bacterial infection. They should be differentiated because their management is quite different.
It is more common in diabetic individuals, those with poor immune function, poor personal cleanliness, or following prolonged antibiotic therapy. The normal symptom is more itching or burning than pain. The area can be a bright red, well-marked rash and occasionally tiny satellite pustules around it. There is usually a thick, white, curd-like discharge beneath the foreskin. The skin may be shiny and wet.
Balanitis is most commonly due to Streptococcus or Staphylococcus bacteria. More painful and tender than itch, and the true redness is diffused with glans swelling and possibly pus. The discharge, if any, is yellow or green and possibly smelly. The skin is warm and, in the more severe forms, erosions or ulceration may be seen.
A doctor may diagnose fungal balanitis visually and also confirm it by the appearance of a specimen under a microscope following a potassium hydroxide (KOH) preparation, which demonstrates the fungal structures. For bacterial balanitis, a culture may be taken and sent out to determine the organism and which antibiotic will best cure it.
Treatment Approaches
For balanitis caused by fungus, the condition can be treated with a one to two week course of topical antifungal creams such as clotrimazole or miconazole. One dose or short course of oral fluconazole is required for more widespread or chronic infection.
For balanitis caused by bacteria, topical antibiotics of the mupirocin type or fusidic acid type should be applied for mild infections and severe infections treated orally with antibiotics of the flucloxacillin type or cephalexin type.
Irrespective of the cause, hygiene must be good. The area must be washed with lukewarm water and mild soap and not with harsh cleanser or scrubbing. Underlying conditions, especially diabetes, must be treated to avoid recurrence.
Conclusion:
Anti-tubercular drugs remain a foundation against TB but at the price of strict adherence and close monitoring. Alternatively, finding out if balanitis is fungal or bacterial ensures proper treatment is administered in good time. Although TB treatment is protracted and with many drugs, balanitis is quick to heal once properly diagnosed and treated. In either case, heeding doctors’ counsel and completing the course of treatment is the guaranteed way to full recovery.
