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Cme tb 2

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  • 1. 04/19/11
  • 2. TB MANAGEMENT
  • 3. Aims of treatment
    • To reduce morbidity
    • To prevent mortality
    • To prevent relapse of tuberculosis
    • To decrease transmission
    • To prevent the emergence of MDR TB
  • 4. Treatment of TB
    • Responsibility is to the public health, not patient
    • Patient centered
    • Each patient management plan should be individualised
    • DOTS
  • 5.
    • Isoniazid (H)
    • Rifampicin ( R )
    • Pyrazinamide (Z)
    • Streptomycin (S)
    • Ethambutol (E)
  • 6. Patient Monitoring
    • Treatment response
      • All patients with positive sputum have repeat sputum smears every two months
    • Patient compliance by DOTS
    • Hospitalisation
      • Gravely ill, acute disseminated TB,TB of vital organs,MDRTB,frequent defaulters,complications, severe side effects, homelessness
  • 7. Category I Category II Category III New case Chronic case Relapse Sputum neg Treatment failure Treatment after interruption Refer to physician/chest Sputum positive, MO CAN treat
  • 8.
    • Intensive phase
      • 2SHRZ or 2EHRZ or 2HRZ two months of daily doses
    • Continuation phase
      • 4H 2 R 2 or 4S 2 H 2 R 2 or 4HR or 4H 3 R 3 or 4S 3 H 3 R 3 durations extended for severe form of TB or extrapulmonary TB
  • 9.
    • Send MTB C&S (rapid culture if available)
    • Do not initiate standard treatment
    • Refer to chest physician or physician in charge of chest clinic
    • Subsequent drug regimen based on sensitivity results and clinical response
  • 10.
    • Send MTB C&S (Rapid culture if available)
    • Refer to chest physician or physician in charge of chest clinic
  • 11. Daily dosage Biweekly dosage mg/kg max mg/kg max Isoniazid H 5-8 300 15-20 1200 Rifampicin R 10-15 600 15-20 600 Streptomycin S 15-20 1000 15-20 1000 Ethambutol E 15-25 1200 50 2000 Pyrazinamide Z 20-40 1500 50 3000
  • 12.  
  • 13. 2SHRZ/2EHRZ 4SHR 2 4HR 2 Continue Rx Continue Rx Completion of 6 mo Rx Follow up Baseline Ix:FBC,LFT,RP,HIV,RBSSpt AFBs DS, AFB culture Spt AFB DS, spt culture if smear positive,CXR Spt AFB DS, CXR Spt AFB DS, CXR Spt AFB, CXR 1. 0 mo (0 w) 2. 2 mo (8w) 3. 2 mo (8w) 4. 2m (8w) 5. 6mo(24w)
  • 14. 04/19/11 STRATEGY OF TREATMENT
  • 15. WHAT IS MULTI DRUG RESISTANT TB? MDR TB IS A SPECIFIC FORM OF DRUG RESISTANT TB DUE TO A BACILLUS RESISTANT TO ATLEAST ISONIAZID AND RIFAMPICIN, THE TWO MOST POWERFUL ANTI TB DRUGS.
  • 16.  
  • 17. MDR TB is a man made disease! The best treatment for MDR-TB is prevention by good management
  • 18. Problems in MDR-TB management
    • High cost of drugs (100x more expensive)
    • 2. Availability of drugs
    • 3. Drug toxicity
    • 4. Duration of treatment
    • 5. Isolation precautions
    • 6. Infectivity
  • 19. Contributing factor leading to MDR-TB Defaulters: leads to resistance so please ensure your patients do not default Doctor: inadequate dosage and drugs lead to resistance so please ensure the drug dosage is correct
  • 20. NOTIFICATION!!!!!
  • 21.
    • Family members
    • Workplace
    • Close contacts
    • Inmates
    • Institution
  • 22.