4.Dots
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Transcript of 4.Dots
TREATMENT OF TUBERCULOSIS
TREATMENT OF TUBERCULOSIS
REVATHY.VROLL NO. 62
OBJECTIVES OF TREATMENT1.TO DECREASE MORTALITY AND LONG TERM MORBIDITY BY ENSURING PERMANENT CURE2. TO DECREASE TRANSMISSION OF INFECTION3. TO ACHIEVE THE ABOVE WHILE MINIMISING SIDE EFFECTS DUE TO DRUGS.
DOTS
ANTI- TB DRUGS
FIRST LINE SECOND LINE
ISONIAZID THIOACETAZONERIFAMPICIN PASPYRAZINAMIDE ETHIONAMIDEETHAMBUTOL CYCLOSERINESTREPTOMYCIN KANAMYCIN
CAPREOMYCINAMIKACIN
NEWER DRUGS
CIPROFLOXACINOFLOXACINCLARITHROMYCINAZITHROMYCINRIFABUTIN
CONVENTIONAL CHEMOTHERAPYISONIAZID ALONG WITH ONE OR MORE BACTERIOSTATIC DRUGSDURATION: 18 MONTHS
REGIMENS:
DAILY REGIMENSINTERMITTENT REGIMENS
SHORT COURSE CHEMOTHERAPY(SCC)
DURATION 6-9 MONTHS
ADVANTAGESRAPID BACTERIOLOGICAL CONVERSIONLOWER FAILURE RATESREDUCTION IN EMERGENCE OF DRUG RESISTANT BACILLI
TWO PHASES
INTENSIVE PHASE1-3 MONTHSTO KILL OFF AS MANY FAST MULTIPLYING BACILLI AS POSSIBLE
CONTINUATION PHASE4-6 MONTHSTO KILL THE REMAINING DORMANT BACILLI
CHEMOTHERAPY AND DOTS
REVATHY.VROLL NO. 62THENDRAL’06
DIRECTLY OBSERVED TREATMENT
SHORTCOURSE(DOTS)
INTENSIVE PHASE
UNDER DIRECT SUPERVISION OF A HEALTH WORKER OR TRAINED PERSON
CONTINUATION PHASEA MULTIBLISTER COMBIPACK WITH DRUGS FOR 1 WEEK IS GIVEN OF WHICH THE FIRST DOSE IS TAKEN UNDER SUPERVISION
•PATIENT WISE BOXES•THRICE WEEKLY REGIMEN-MORE EFFECTIVE
TUBERCULOSIS CASE DEFINITIONS
PULMONARY TUBERCULOSIS, SMEAR POSITIVEPULMONARY TUBERCULOSIS, SMEAR NEGATIVEEXTRA PULMONARY TUBERCULOSIS
TYPE OF PATIENTS
NEWRELAPSETRANSFERRED INTREATMENT AFTER DEFAULTFAILURECHRONICOTHERS
TREATMENT OUTCOME
CUREDTREATMENT COMPLETEDDIEDFAILUREDEFAULTEDTRANSFERRED OUT
TREATMENT REGIMENCATEGORY I(RED BOX)
INDICATIONS
NEW SPUTUM SMEAR POSITIVESERIOUSLY ILL SPUTUM SMEAR- NEGATIVESERIOUSLY ILL EXTRA- PULMONARY
REGIMEN2(HRZE)3
4(HR)3
PREPARATION: PATIENT WISE BOXES
IP POUCH : 24 SINGLE DAY STRIPSCP POUCH : 18 WEEKLY BLISTERS
EXTRA-PULMONARY TB- SERIOUSLY ILL
MENINGITISPERICARDITISPERITONITISBILATERAL OR EXTENSIVE PLEURAL EFFUSIONSPINAL TB WITH NEUROLOGICAL INVOLVEMENTINTESTINALGENITO-URINARYCO-INFECTION WITH HIVALL FORMS OF PEDIATRIC EXTRA PULM TB OTHER THAN LYMPH NODE TB AND UNILATERAL PLEURAL EFFUSION
SMEAR NEG PULM TB- SERIOUSLY ILL
MILIARYEXTENSIVE PARENCHYMAL INFILTRATIONCO-INFECTION WITH HIVCAVITARY DISEASEALL FORMS OF SPUTUM SKEAR NEG PULM TB EXCEPT PRIMARY COMPLEX
CATEGORY II(BLUE BOX)
INDICATIONS
SPUTUM SMEAR- POSITIVE RELAPSEFAILURETREATMENT AFTER DEFAULT
REGIMEN:2(HRZES)31(HRZE)35(HRE)3
PREPARATION: PATIENT WISE BOXES
IP POUCH : 36 SINGLE DAY STRIPS WITH 24 SM VIALSCP POUCH : 22 WEEKLY BLISTERS
CATEGORY III(GREEN BOX)
INDICATIONS
NEW SPUTUM SMEAR NEGATIVE, NOT SERIOUSLY ILLNEW EXTRA-PULMONARY, NOT SERIOUSLY ILL
REGIMEN:2(HRZ)34(HR)3
PREPARATION:
IP POUCH : 24 SINGLE DAY STRIPSCP POUCH : 18 WEEKLY BLISTERS
DRUG DOSE
ISONIAZID 600 mg
RIFAMPICIN 450 mg
PYRAZINAMIDE
1500 mg
ETHAMBUTOL 1200 mg
STREPTOMYCIN
750 mg
DOSAGE
PATIENTS WHO WEIGH 60 KG OR MORE – EXTRA I50 MG OF RIFAMPICIN GIVENPATIENTS OVER 50 YEARS OF AGE ARE GIVEN 500MG OF STREPTOMYCIN
PAEDIATRIC DOSAGE
MODE OF ADMINISTRATION:
IP : THRICE WEEKLY(MON, WED, FRI OR TUE, THU OR SAT) EACH DOSE UNDER DIRECT OBSERVATIONCP : THRICE WEEKLY (MON, WED, FRI OR TUE, THURS OR SAT)FIRST DOSE OF THE WEEK UNDER DIRECT OBSERVATION
FOLLOW UP SPUTUM EXAMINATION SCHEDULE
FIRST FOLLOW UP – AT THE END OF INTENSIVE PHASE IN ALL CATEGORIES
SECOND FOLLOW UP – 2 MONTHS AFTER STARTING CONTINUOUS PHASE
FINAL FOLLOW UP – AT THE END OF TREATMENT
FOLLOW UP SPUTUM EXAMINATION SCHEDULE
CAT I 0 2 4 6
+ NEG NEG NEG
0 2 3 5 7
+ + NEG NEG NEG
0 2 3 5 7
+ + + NEG NEG
REACTIONS DRUG RESPONSIBLE
RENAL FAILURE,SHOCK, THROMBOCYTOPENIA
RIFAMPICIN
HEPATITIS PYRAZINAMIDE
VISUAL DISTURBANCE ETHAMBUTOL
HEARING LOSS, DISTURBED BALANCE
STREPTOMYCIN
SEVERE RASH, AGRANULOCYTOSIS
THIOACETAZONE
ADVERSE REACTIONS
TREATMENT UNDER SPECIAL CLINICAL SITUATIONS
HOSPITALIZATIONEXTREMELY ILL
TUBERCULOUS MENINGITISDURATION- 8 -9 MONTHS STEROIDS GIVEN
PREGNANT WOMENSTREPTOMYCIN IS CONTRAINDICATED
WOMEN ON OCPsINCREASE THE DOSAGE OF OCP OR SWITCH OVER TO OTHER METHODS
HEPATOTOXICITY OR HEPATIC DISEASEH, R, Z SHOULD BE AVOIDED
HIV-TBSERIOUSLY ILLHIV STATUS SHOULD NOT BE MENTIONED IN ANY
RECORDSCAT I REGIMENSHOULD BE FIRST TREATED UNDER DOTS
IF CD4 COUNT IS VERY LOW, REPLACE NEVIRAPINE WITH EFAVIRENZ
MDR-TB
ATLEAST RESISTANT TO INH AND RIFAMPICINTREATMENT BASED ON DOTS – PLUS
DOTS- PLUS(CAT IV)INTENSIVE PHASE 6-9 MONTHS
KANAMYCINOFLOXACINCYCLOSERINEETHIONAMIDEETHAMBUTOLPYRAZINAMIDE
CONTINUATION PHASE 18 MONTHSOFLOXACINCYCLOSERINEETHIONAMIDEETHAMBUTOL
XDR-TB
RESISTANT TORIFAMPICIN AND INH(MDR-TB)FLUROQUINOLONE1 OR MORE OF SECOND LINE INJECTABLE DRUGS
ACTION FOR PATIENTS WHO INTERRUPT TREATMENT
VISIT SHOULD BE MADE TO THE PATIENT’S HOME WITHIN 24 HOURS IN INTENSIVE PHASEWITHIN 7 DAYS IN CONTINUATION OHASE
A CHILD AGED 6 YEARS IS FOUND TO BE TUBERCULIN POSITIVE. HE WAS ALREADY VACCINATED FOR BCG. THERE IS ALSO CONTACT OF TUBERCULOSIS.YOU WANT TO FIND IF THE POSITIVITY IS DUE TO BCG VACCINATION OR LATENT TB. HOW WILL YOU FIND?
INTERFERON GAMMA ASSAY