Cme tb 2

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Cme tb 2

  1. 1. 04/19/11
  2. 2. TB MANAGEMENT
  3. 3. Aims of treatment <ul><li>To reduce morbidity </li></ul><ul><li>To prevent mortality </li></ul><ul><li>To prevent relapse of tuberculosis </li></ul><ul><li>To decrease transmission </li></ul><ul><li>To prevent the emergence of MDR TB </li></ul>
  4. 4. Treatment of TB <ul><li>Responsibility is to the public health, not patient </li></ul><ul><li>Patient centered </li></ul><ul><li>Each patient management plan should be individualised </li></ul><ul><li>DOTS </li></ul>
  5. 5. <ul><li>Isoniazid (H) </li></ul><ul><li>Rifampicin ( R ) </li></ul><ul><li>Pyrazinamide (Z) </li></ul><ul><li>Streptomycin (S) </li></ul><ul><li>Ethambutol (E) </li></ul>
  6. 6. Patient Monitoring <ul><li>Treatment response </li></ul><ul><ul><li>All patients with positive sputum have repeat sputum smears every two months </li></ul></ul><ul><li>Patient compliance by DOTS </li></ul><ul><li>Hospitalisation </li></ul><ul><ul><li>Gravely ill, acute disseminated TB,TB of vital organs,MDRTB,frequent defaulters,complications, severe side effects, homelessness </li></ul></ul>
  7. 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. 8. <ul><li>Intensive phase </li></ul><ul><ul><li>2SHRZ or 2EHRZ or 2HRZ two months of daily doses </li></ul></ul><ul><li>Continuation phase </li></ul><ul><ul><li>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 </li></ul></ul>
  9. 9. <ul><li>Send MTB C&S (rapid culture if available) </li></ul><ul><li>Do not initiate standard treatment </li></ul><ul><li>Refer to chest physician or physician in charge of chest clinic </li></ul><ul><li>Subsequent drug regimen based on sensitivity results and clinical response </li></ul>
  10. 10. <ul><li>Send MTB C&S (Rapid culture if available) </li></ul><ul><li>Refer to chest physician or physician in charge of chest clinic </li></ul>
  11. 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)
  13. 14. 04/19/11 STRATEGY OF TREATMENT
  14. 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.
  15. 17. MDR TB is a man made disease! The best treatment for MDR-TB is prevention by good management
  16. 18. Problems in MDR-TB management <ul><li>High cost of drugs (100x more expensive) </li></ul><ul><li>2. Availability of drugs </li></ul><ul><li>3. Drug toxicity </li></ul><ul><li>4. Duration of treatment </li></ul><ul><li>5. Isolation precautions </li></ul><ul><li>6. Infectivity </li></ul>
  17. 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
  18. 20. NOTIFICATION!!!!!
  19. 21. <ul><li>Family members </li></ul><ul><li>Workplace </li></ul><ul><li>Close contacts </li></ul><ul><li>Inmates </li></ul><ul><li>Institution </li></ul>

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