Treatment Bed rest doesn’t affect outcome Hospitalisation: – Ill, smear positive, highly infectious patients – Esp in multi-drug resistant TB Continuous self-admin of drugs for 6 months vital for successful Rx – Lack of compliance  5% pts unresponsive to Rx – Resistance to anti-TB drugs increasing Isoniazid resistance 4-6% Multidrug resistance 1% Before treatment: – Test FBC, liver, and renal function Need to alter dosages in pts with liver/renal failure – Test colour vision & acuity Ethambutanol can cause (reversible) ocular toxicity

Treatment 6 months – Rifampicin mg, daily – Isoniazid 300 mg daily – Pyrazinamide 2.5g, 3/week First 2 months – Ethambutanol 30 mg/kg 3/week First 2 months Longer regimen: – For bone TB (9 months), tuberculosis meningitis (1yr) NEVER use monotherapy – Except when using Isoniazid for latent TB Rx DOTS: Directly Observed Therapy (short-course) – WHO incentive, to improve detection and compliance – DOT plan: treating physician/TB nurse – Bi-weekly, thrice-weekly treatment instead of daily

Side Effects Rifampicin: – Hepatitis – Small rise in AST acceptable – Stop if bilirubin rises – Orange discolouration of urine & tears – Inactivation of the Pill Isoniazid – Hepatitis – Neuropathy – Pyridoxine deficit – Agranulocytosis Ethambutanol – Optic neuritis (colour vision fist to deteriorate) – Pyrazinamide: Hepatitis – Athralgia (CI: gout, prophyria)

Resistance Seen in non-compliant pts MDR (multi-drug resistance) – High mortality (esp in HIV pts) Use at least 3 drugs to which organism is sensitive Follow-up – Patients should be seen regularly for duration of chemotherapy – Once more after 3 months to check for relapse Chemoprophylaxis: – Pts with x-ray xhanges compatible with TB, but about to undergo immunosuppresive long-term Rx (ie dialysis) – Isoniazid mg/day