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					          Module 4
Basic Principles of Treatment
Active TB Patient




                                                                     In Loving Memory of
                       Did not take                   Did not take
                        medication                     medication

 “ubo! ubo! ubo!”
 (cough for 2 weeks or more)
                                      Cough worsens                   DEAD

                      Not taking medication
Active TB Patient




                  Takes medication                             Medication is
                                                              Discontinued or
                                                                 irregular
“ubo! ubo! ubo!”                     Feels better but bacteria                  Coughing recurs &
(cough for 2 weeks or more)          is still present in the lungs              Bacteria multiplies




            Not regularly taking medication
Active TB Patient




                       Takes medication                               Takes medication
                           (2 mos.)                                      (4-6 mos.)


                                          Feels better but bacteria
“ubo! ubo! ubo!”
(cough for 2 weeks or more)               is still present in the lungs                  cured


               Regularly taking medication
Basic Principles of Treatment


 Patients should be given the safest, most effective therapy in
 prescribed duration.

 Multiple drugs to which the organisms are (likely) susceptible
 must be chosen.

 Addition of a single drug to a failing regimen is not
 recommended.

 Patient’s complete adherence to therapy must be ensured.   –
 DOTS for all!
Basic Principles of Treatment

 FIRST LINE ESSENTIAL DRUGS
        Rifampicin – bactericidal, extra/intra-cellular

         Isoniazid – bactericidal, extra-cellular


 FIRST LINE SUPPLEMENTAL DRUGS
        Pyrazinamide – weakly bactericidal, w/in
                  macrophages, acute inflammation

         Ethambutol – bacteriostatic/cidal at higher doses;
                  extra/intra cellular

         Streptomycin – bactericidal
Rifampicin


  • Interacts with oral contraceptive pills, seizure meds, warfarin,
    methadone / opiates

  • Major side effects: Hepatitis (nausea, vomiting, abdominal pain,
    jaundice)
     – Contraindicated in GI distress and rash

      – Bleeding problems, flu-like symptoms

      – Risk increases with alcoholism, liver disease, and use of other
        hepatotoxic drugs
Isoniazid


  • Major side effects: Hepatitis (nausea, vomiting, abdominal pain,
    jaundice)

  • Risk increases with alcoholism, presence of liver disease, use of
    other medications
     – Other contraindications: GI distress and rash

      – Occasional peripheral neuropathy preventable with Vitamin
        B6 supplementation
Pyrazinamide


  • Major side effects: Hepatitis (nausea, vomiting, abdominal pain,
    jaundice)

  • Risk increases with liver disease, alcoholism, other hepatotoxic
    drugs
     – Other common C/I include GI distress and rash

     – Joint aches, and hyperuricemia
Ethambutol


  • Major side effects: Optic Neuritis (blurred vision, altered color
    vision)

  • Visual monitoring suggested while on treatment
Streptomycin


  • Administered via intra-mascular (IM) route

  • May be substituted by kanamycin, capreomycin, or amikacin.

  • Major side effects: ear damage (balance problems, hearing loss,
    ringing in the ear); kidney damage
Symptom-based Approach to Adverse Effects of TB Drugs


 Side effects           Drugs probably       Management
                        responsible

 Minor
 Anorexia, nausea,      Rifampicin           Give drugs last thing
 abdominal pain                              at night

 Joint pains            Pyrazinamide         Aspirin/ NSAIDS

 Burning sensation      Isoniazid            Pyridoxine
                                             100mg/day
 Orange-red urine       Rifampicin           Reassurance
Symptom-based Approach to Adverse Effects of TB Drugs


 Major
 Deafness (no gross            Streptomycin      Stop S, use E
 abnormality on otoscopy)
 Dizziness (vertigo and        Streptomycin      Stop S, use E
 nystagmus)
 Jaundice                      Isoniazid,        Stop drugs, re-
                               Rifampicin, PZA   introduce
 Vomiting and Confusion        Most anti-TB      Stop drugs, urgent
 (suspect drug-induced liver   drugs             liver function tests
 failure)                                        and PT

 Visual impairment (other      Ethambutol        Stop E
 causes excluded)
 Shock, Purpura, ARF           Rifampicin        Stop Rifampicin

				
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posted:2/26/2012
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