TB/NTM Flashcards
What is the usual regime for TB?
all 4 for 2 months and then just iso and rifamp for 4 months for pulmonary disease
latent: 3RH or 6H (if hep risk)
ocular disease- 10-12 months
CNS 10+months
LN disease- 6 months
When are steroids indicated for TB?
active CNS disease
Pericardial
In isoniazid (H) resistance how would you change your treatment?
Depends on risk/burden of disease/country of high resistance.
but you would complete initiation with REZ and then do continuation with RE for 7-10 months
in which order is there resistance likely in the UK?
isoniazid (H)
pyrazinamide (Z)
rifamp (R)
etham (E)
In pyrazinamide (Z) resistance how would you change your treatment?
2 months RHE and then 7months RH
In ethambutol (E) resistance how would you change your treatment?
2 months RHZ and then 4months RH
What is the regime in MDRTB?
bedaquiline, pretomanid, linezolid and moxifloxacin 6months- but can be 9
as long it is not complicated
other regimes include
6 bdq-cfx-lfx-Z-E-hH-Eto/5 cfx-lfx-Z-E
when do you treat latent TB?
16-65 yr old
close contacts
healthcare workers with no Hx of TB from high risk areas
prior to biologics (pos quant)
What proportion of latent patients develop TB?
5-10% lifetime risk
How do you treat NTM?
RE plus azithro/clari
+/-amikacin in cavitatory disease
What is the treatment for NTM?
Rifamp+Etham +…
MAC, malmoense- clari or azithro
xenopi- clari or azithro plus quinolone/iso
kansasii- clari or iso
abscessus is special-
1. initially 4 weeks of IV amikacin, IV tigecycline, IV imipenem and oral clari (if no resistance) then
2. Neb amikacin and clari/azi in combo with 1-3 of: doxy, moxiflox, cipro, co-trimox, linezolid, clofazimine
Which NTM are slow growing?
MAC, M kansasii, M malmoense, M xenopi
WHich NTM are fast growing?
M abscessus, M chelonae, M fortuitum
What is Lady Windermere syndrome?
Described as nodular bronchiectatic NTM disease.
normally affects women- tall, thin, white women with PECTUS EXCAVATUM, scoliosis and MVP who develop RML and lingular bronchiectasis
What is specific mac treatment?
Non severe- smear neg etc:
Rifamp 600mg x3/week, etham 25mg/kg x3/week and azi/clari X3/week
Severe:
Smear pos etc:
Rifamp 600 OD, etham 15mg/kg OD and azi/clari OD + consider neb amikacin for 3mo
What is Eales disease?
retinal vasculitis characterised by occlusive disease and neovascularisation, leading
to recurrent vitreous haemorrhage and tractional retinal
detachment
SHOULDN’T be used in TB but often is
In ocular TB, how long do you treat and what with?
6 months as per NICE, but under MDT can be 12 months depending on severity and response to treatment. You replace ethambutol with Moxiflox or Levoflox in view of eye SE of ethambutol
How does anti-TB treatment work in ocular TB?
Treats systemic inflammation (ie the cause of inflammation) doesn’t act directly on the Uvea
