Tuberculosis Flashcards
What are the two phases of the standard treatment of active tuberculosis?
- Initial phase (4 drugs)
2. Continuation phase (2 drugs)
What are the names of the two regimens recommended for the treatment of TB in the UK?
- Unsupervised
- Supervised (directly observed therapy, DOT)
The choice of either regimen is dependent on a risk assessment to identify if an individual needs enhanced case management.
What 4 drugs are used in the standard treatment of TB during the initial phase of therapy?
- Rifampicin
- Ethambutol hydrochloride
- Pyrazinamide
- Isoniazid (with pyridoxine hydrochloride)
Continue for 2 months
How long is the initial phase of TB therapy?
2 months
4 drugs are used: rifampicin, ethambutol hydrochloride, pyrazinamide and isoniazid (with pyridoxine hydrochloride)
Do you wait for culture results to come back before starting initial therapy of TB if the patient has clinical signs and symptoms consistent with a TB diagnosis?
NO - start immediately
Also consider completing the standard treatment even if subsequent culture results are negative
A patient has clinical signs and symptoms consistent with a TB diagnosis, you start therapy before the culture results come back. If the culture results are negative do you continue to complete the standard treatment?
Yes (consider completing the standard treatment even if subsequent culture results are negative)
Which 2 drugs are used in the standard continuation phase of TB therapy?
- Rifampicin
- Isoniazid (with pyridoxine hydrochloride)
For 4 months in individuals with active TB without CNS involvement.
For 10 months in individuals with active TB with CNS involvement
A patient has completed the initial phase of TB therapy, how long is the continuation phase if the patient has active TB WITHOUT CNS involvement?
4 months
A patient has completed the initial phase of TB therapy, how long is the continuation phase if the patient has active TB WITH CNS involvement?
10 months
Which patients can have the unsupervised TB treatment regimen?
Individuals who are likely to take antituberculosis drugs reliably and willingly without supervision
In the supervised TB treatment regime, what is the minimum number of times the patient needs to come in for direct observation?
3 times weekly (if daily direct observed therapy, DOT, is not available)
Which individuals are offered the supervised (directly observed therapy, DOT) TB treatment? (9)
- Current risk or history of non-adherence
- Previously been treated for tuberculosis
- History of homelessness, drug or alcohol misuse
- In prison or a young offender institution, or have been in the past 5 years
- Major psychiatric, memory or cognitive disorder
- In denial of the TB diagnosis
- Multi-drug resistant TB
- Request directly observed therapy after discussion with the clinical team
- Too ill to self-administer treatment
If a patient has Tb with CNS involvement, which drug should be added to their treatment in addition to anti-TB medications?
High dose dexamethasone or prednisolone
Slowly withdrawn over 4-8 weeks
What three indications to refer a patient with TB with CNS involvement to surgery?
- Raised intracranial pressure
- Spinal TB with spinal instability
- Spinal TB with evidence of spinal cord compression
What drug should be given in addition to anti-TB medication for a patient with active pericardial TB?
High dose of oral prednisolone
Slowly withdrawn over 2-3 weeks
Which individuals with latent tuberculosis are at increased risk of developing active TB? (4)
- HIV-positive
- Diabetic
- Injecting drug users
- Receiving treatment with an anti-tumor necrosis factor alpha inhibitor
What is the age cut off for close contacts of pulmonary or laryngeal TB to be tested for latent TB?
Close contacts under 65 years of age should be tested for latent TB
Close contact = prolonged, frequent or intense contact, e.g. household contacts or partners
Who should drug treatment be offered to if they are close contacts of TB?
All individuals under 65 years with evidence of latent TB, if the close contact has suspected infectious or confirmed active pulmonary or laryngeal drug-sensitive TB
What is the treatment for latent TB? (2 regimens)
3 months of isoniazid (with pyridoxine hydrochloride) and rifampicin
OR
6 months of isoniazid (with pyridoxine hydrochloride)
Individuals aged 35 to 65 years with latent TB should only be offered treatment if (?) is not a concern
hepatotoxicity