TB treatment

Question 1

How do you manage latent TB?

Answer 1

If worried about hepatotoxicity:
- 3 months of isoniazid (with pyridoxine) and rifampicin

If worried about interactions with rifampicin (HIV and transplant patients):
- 6 months isoniazid (with pyridoxine)

Question 2

How do you manage active TB?

Answer 2

RIPE
- R - Rifampicin 450mg (<50kg), 600mg (≥50kg) 
      6 months
- I - Isoniazid 300mg
      6 months
- P - Pyrazinamide 1.5g (<50kg), 2g (≥50kg) 
      2 months 
- E - Ethambutol 15mg/kg 
      2 months

Question 3

What are the side effects of rifampicin?

Answer 3

• Red/orange coloured body fluids
• Hepatits
• Skin reactions
• Flu syndrome
• GI symptoms
• Thrombocytopenia
• Reduced effect of drugs metabolised by cytochrome P450 enzymes (OCP)

Question 4

What are the side effects of isoniazid?

Answer 4

• Hepatitis
• Skin reactions
• Peripheral neuropathy

Question 5

What are the side effects of pyrazinamide?

Answer 5

• Hepatitis
• Flushing
• GI symptoms
• Arthralgia
• Hyperuricaemia (gout)
• Skin reactions

Question 6

What are the side effects of ethambutol?

Answer 6

• Retrobulbar neuritis
  Can result in blindness -> stop treatment
  Eye-thambutol
• Arthralgia

Question 7

What do you need to give with isoniazid?

Answer 7

Pyridoxine (vitamin B6) for peripheral neuropathy

- Im-so-numb-azid

Question 8

How long do you continue treatment for if there are meningeal/CNS symptoms?

Answer 8

10 months

Question 9

How long do patients need to isolate for before they are established onto treatment?

Answer 9

• 2 weeks