Tuberculosis

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TB guideline

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Tuberculosis

  1. 1. TUBERCULOSIS WHO guideline 2010
  2. 2. Case definition • TB suspected : • productive cough > 2 weeks • Constitual symptom : loss of apetite , weight loss , fever night • Respiratory symptom :shortness of breath ,chest pain , hemoptysis • Case of TB • Definite case + treat TB • Definite case of TB • ≥1 sputum AFB +ve or C/S or molecular lne probe assay
  3. 3. Treatment • First line antituberculosis drugs • Isoniazid 5MKD – max < 300mg/day • Rifampicin 10MKD – max <600mg/day • Streptomycin 15MKD • Age >60 yrs • BW < 50kgs may not tolerate dose >500-750mg/day may not tolerate dose >500-750mg/day • Ethambutol 15MKD • Pyrazinamide 25MKD(20-30 MKD)
  4. 4. Treatment regimen • New patient : • 2IRZE/4IR standard TB meningitis—streptomycin replace to etham • High incidence INH resist : 2IRZE/4IRE • AFB+ after 2IRZE – repeat sputum 3rd month AFB+ : DST • Previous treatment: • Default /relapse : 2IRZES/1IRZE/5IRE • Treatment failure : empirical MDR regimen HIV CD4< 200cell/cc sputum AFB + ส่ง DSTทุก ราย Pyridoxine 10mg/day– INH S/E
  5. 5. Treatment regimen • Extrapulmonary tuberculosis • TB meningitis • Extended regimen • Change etham to streptomycin • Add dexa if not wonder drug resistance • TB bone and joint • Extended regimen
  6. 6. Treatment regimen • HIV co-infection • Start anti TB drug and start ARV within 8 wks • ARV regimen 3TC/AZT 3TC/TDF EFV NVP
  7. 7. Follow up • 2IRZE/4IR regimen • Sputum AFB at 2nd , 5th , 6th month • If 2nd month sputum AFB+ repeat at 3rd month • If 3rd , 5th ,6th month sputum AFB + --- DST • 2IRZES/1IRZE/5IREregimen • Sputum AFB at 3rd , 5th , 8th month if +ve -- DST
  8. 8. Follow up • Sputum AFB +ve after intensive phase • Poor adherance and compliance • Low quallity antiTB drug • Lower than standard dose treatment • Numerous TB load α extensive cavitation • MDR TB • Sputum AFB +ve but not alive
  9. 9. Adverse drug reaction • Minor adverse effect • Close observe clinical , symptom base approach • Major adverse effect • Stop antiTB drug +admit for observe clinical
  10. 10. Cutaneous reaction • No skin rash but isching – antihistamine+skin moisturizing • Skin rash • stop anti TB drug and rechallange when full recovery • INH / rifam low dose and increase dose
  11. 11. Drug induced hepatitis • Hepatitis : INH , PZA , rifampicin • Jaundice : rifampicin • Rechallange • Stop antiTB drug and start EOS regimen for 2wks • If continuation phase • INH not include : 6-9 RZE • Start rifampicin 3-7days and 2nd INH if no hepatitis • PZA include – IRZE • PZA not include –2IRES/6IR • Rifam+PZA not include – 2IES/10IE • INH+rifam not include – 18-24EOS
  12. 12. Pregnancy and breast feeding • 2IRZE/4IR • Streptomycin : contraindication ototoxicity in fetus • INH prophylaxis in children for 6 months • Pyridoxine supplement
  13. 13. Liver disease • 2 hepatotoxic drugs • 9IRE • 2IRSE/6IR • 6-9RZE • 1 hepatotoxic drug • 2IES/10IE • No hepatotoxic drug • 18-24 EOS
  14. 14. Renal disease • 2IRZE/4IR • INH , rifampicin – no adjust dose • Ethambutal , PZA – 3 times/ wk + adjust dose • Adjust dose • Ethambutal 15 Mg//kg/time • PZA 25 Mg/kg/time Pyridoxine 15-50mg/day for INH

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