Case Conference 4

Section C - Group 5 Mendoza, T., Mindanao, A., Miranda, M.C., Molina, M., Monzon, J.,Morales, A., Musni,

M., Nallas, A., Naval, A., Nepomuceno, J., Nerpiol, C., Ng, C., Ng, P., Niere, J

Recommended Dosage for Initial Treatment of Tuberculosis in Adults:

Drug DOSAGE

Daily dose Thrice-weekly dose

Isoniazid 5 mg/kg, max 300 mg

15 mg/kg, max 900 mg

Rifampicin 10 mg/kg, max 600 mg

10 mg/kg, max 600 mg

Pyrazinamide 20-25 mg/kg , max 2 g

30-40 mg/kg, max 3 g

Ethambutol 15-20 mg/kg 25-30 mg/kg

Recommended Antituberculosis Treatment Regimen:Indication Initial Phase Continuation Phase

Duration, months Drugs Duration, months Drugs

New smear or culture positive case

2 HRZE 4 HR

New culture negative cases

2 HRZE 7 HR

Pregnancy 2 HRE 2 HR

Failure and relapse - - - -

Resistance (or tolerance) to H

Throughout (6) RZE

Resistance to H + R Throughout (12-18) ZEQ + S (or another injectable agent)

Resistance to all first-line drugs

Throughout (4) 1 injectable agent + 3 of these 4: ethionamide, cycloserine, Q, PAS

Standardized re-treatment (susceptibility testing unavailable)

3 HRZES 5 HRE

Intolerance to R Throughout (12) HZE

Intolerance to Z 2 HRE 7 HR

Criteria for ARDS• Acute in onset • Oxygenation: A partial pressure of arterial oxygen to

fractional inspired oxygen concentration ratio < 200 mm per Hg (regardless of positive end-expiratory pressure. ) • Bilateral pulmonary infiltrates on chest radiograph • Pulmonary artery wedge pressure < 18 mm Hg or no

clinical evidence of left atrial hypertension

Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818-24.

Harrison’s Principle of Internal Medicaine 17th Edition

Clinical Conditions Associated with Development of Acute Respiratory Distress Syndrome

Direct lung injury Indirect lung injury

• Pneumonia• Aspiration of gastric contents• Toxic Inhalation injury• Near drowning• Pulmonary contusion• Fat embolism• Reperfusion pulmonary edema

post lung transplantation or pulmonary embolectomy

• Sepsis• Severe trauma– Multiple bone fractures– Flail chest– Head Trauma– Burns

• pancreatitis• Post-Cardiopulmonary bypass• Massive transfusions• Drug overdose

Ware LB, Matthay MA. The acute respiratory distress syndrome. N Engl J Med 2000;342:1338.

Harrison’s Principle of Internal Medicaine 17th Edition