Contd… PPI / Antiemetics Eto, Pto, PAS R Gastritis Thyroxine PAS, Eto, Pto Hypothyroidsm Change to Cm AG Clr Hearing loss Management Drugs responsible Adverse effects
Contd… Stop E Optic neuritis NSAID Dose / Stop Z Arthralgia Replace Cm AG Electrolyte disturbances (K, Mg ) Use Cm Give bi / tri wkly. AG Renal toxicity Management Drugs responsible Adverse effects
Revised National Tuberculosis Control Programme (RNTCP)
1963 – Launching of NTP.
1993 – NTP declared a failure.
1993 – 1996 – Pilot Programme
1997 – Formal Launching Of RNTCP
2007 – 632 districts – 1114 million people covered
6 months but prolonged to 9 months in delayed clinical (sym.) / microbiologic response (culture +ve at 2 months)
Treatment failure & relapse is related to:
Advanced immuno deficiency.
Acquired Rifamycin resistance (common in intt. ATD).
So daily ATD.
Overlapping adverse event profile - ZDV CTMX Valganciclovir Bone marrow dysplasia RBT, R Pancytopenia - d4T, ddl & ddc - - H & E Peripheral neuropathy + in pts. With chr. Viral hepatitis NVP, all PI CTMX - ZRH, RBT Hepatitis - Ddl - - E, RBT Ocular Effects + Pancreatitis or Intra – abd. Adenitis ZDV, r, IDV - Do - Other opp infections - Do - Nausea Vomiting - NVP, EVP, ABC CTMX Folliculitis ZRH, RBT Skin Rash IRS ARV drugs Medication other than ARV HIV ATT Possible Causes Adverse Effects
Definition : Restoration of immunity by ARV therapy leading to increased inflammation in TB resulting in significant worsening of S / S (Paradoxical reactions)
Onset – Within days of ARV therapy or months after ARV initiation.
Symptoms : Fever, adenopathy, increased pulmonary infiltrates, serositis. Less common features are worsening of meningitis, increased CNS tuberculomas, soft tissue & bone abscess & diffuse skin lesions.
DOTS PLUS is a comprehensive management strategy that includes five tenets of DOTS strategy. It considers specific issues (eg. use of reserve drugs) that needs to be addressed in high MDR TB areas.
Green Light Committee is a working group that has made arrangement with the pharmaceutical industry to provide concessionally - priced 2 nd line anti TB drugs to DOTS PLUS pilot projects for management of MDR TB.
No adverse effect of pregnancy on TB & vice – versa.
Effect of maternal TB on baby. Examine placenta.
Treatment is the same (avoid Sm Eto Pto).
Management of new born
Don’t separate (unless mother is desperately ill)
If mother Sp. –ve give BCG
If mother is / was Sp. +ve during pregnancy / delivery
If baby ill & TB suspected – full ATD
If baby well - give INH 5 mg. / Kg. X2 months. Then MT done. If MT –ve – stop INH. Give BCG. If MT +ve – give INH upto 6 months.
If mother MDR – start Tt. in 2 nd trimester with 3 – 4 oral drugs (except Am, Eto, Pto)
Management of latent TB – Indications of Tt. Silicosis / DN / malignancy Chr. immunosupression Lab personnel Prior TB (fiibrosis) Residents & employees of high risk setup. Recent contact No risk persons Immigration HIV +ve 15 mm. induration 10 mm. induration 5 mm. induration
Where youth grows pale, and spectre-thin, and dies; Where but to think is to be full of sorrow And leaden-eyed despairs, Where Beauty cannot keep her lustrous eyes, Or new Love pine at them beyond to-morrow.