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Module 4 Basic Principles of Treatment
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“ubo! ubo! ubo!” (cough for 2 weeks or more) Did not take medication medication In Loving Memory of In Loving Memory of DEAD Not taking medication Cough worsens Did not take medication medication Active TB Patient
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“ubo! ubo! ubo!” (cough for 2 weeks or more) Not regularly taking medication Takes medication Medication is Discontinued or irregular Coughing recurs & Bacteria multiplies Feels better but bacteria is still present in the lungs Active TB Patient
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Takes medication (2 mos.) Takes medication (4-6 mos.) Feels better but bacteria is still present in the lungs cured Regularly taking medication “ubo! ubo! ubo!” (cough for 2 weeks or more) Active TB Patient
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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
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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 Basic Principles of Treatment
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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 Rifampicin
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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 Isoniazid
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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 Pyrazinamide
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Major side effects: Optic Neuritis (blurred vision, altered color vision) Visual monitoring suggested while on treatment Ethambutol
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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 Streptomycin
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ReassuranceRifampicinOrange-red urine Pyridoxine 100mg/day IsoniazidBurning sensation Aspirin/ NSAIDSPyrazinamideJoint pains Give drugs last thing at night RifampicinAnorexia, nausea, abdominal pain Minor ManagementDrugs probably responsible Side effects Symptom-based Approach to Adverse Effects of TB Drugs
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Stop RifampicinRifampicinShock, Purpura, ARF Stop EEthambutolVisual impairment (other causes excluded) Stop drugs, urgent liver function tests and PT Most anti-TB drugs Vomiting and Confusion (suspect drug-induced liver failure) Stop drugs, re- introduce Isoniazid, Rifampicin, PZA Jaundice Stop S, use EStreptomycinDizziness (vertigo and nystagmus) Stop S, use EStreptomycinDeafness (no gross abnormality on otoscopy) Major Symptom-based Approach to Adverse Effects of TB Drugs
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