Tuberculosis Flashcards
What is tuberculosis?
An infection of lungs caused by mycobacterium tuberculosis
How is tuberculosis treatment catergorised?
2 stages
Initial stage which uses FOUR drugs
Used to rapidly clear the bacterial population and prevent resistance
Treatment for 2 months
Continuation phase which uses TWO drugs
Continued for 4 months
What drugs are used in the initial phase of treatment?
Taken daily
R= Rifampicin
I= Isonaizid
(ideally in combination with pyridoxine as it can cause peripheral neuropathy as vitamin B6 can become deficient during treatment)
P= Pyrazinamide
E= Ethambutol
What is aim of ethambutol in the treatment?
It’s main purpose is a backup in case there is isoniazid resistance
What are benefits of pyrazinamide?
is a bactericidal drug which exerts its main effect only in the first 2 or 3 months.
It is particularly useful for tuberculous meningitis because of good meningeal penetration
What plan can but put in place for patients that cannot comply?
What group of people may be offered?
Supervised treatment plan;
‘directly observed therapy’
Given RIPE three times weekly
Patients with a history of non-adherence
Denial of TB diagnosis
MDR TB
Major psychiatric/cognitive disorder
imprisoned
too ill
drug/alcohol abuse
What is treatment for continuation phase?
isoniazid
Rifampicin
What is treatment for Central nervous system TB?
Initial phase: RIPE with pyridoxine for 2 months
Continuation phase:
Rifampicin and Isoniazid (with pyridoxine) should be continued for a further TEN months.
An initial high dose of dexamethasone or prednisolone should be started at the same time as anti-tuberculosis therapy, and then slowly withdrawn over 4-8 weeks
What is treatment for Pericardial TB
normal therapy (RIPE) with high dose of oral prednisolone at the same time as initiation of anti-tuberculosis therapy.
then slowly withdrawn over 2-3 weeks.
What group of patients are at an increased risk of developing latent TB
HIV positive
diabetic
receiving treatment with a tumour necrosis alpha inhibitor
Who should drug treatment ONLY be given to for latent TB
Patients aged 35-65
+
if hepatotoxicity is not a concern
What can be used for chemoprophylaxis of latent TB?
Isoniazid (with pyridoxine) alone for 6 months
or
Rifampicin + Isoniazid for 3 months (recommended when hepatotoxicity is a concern).
What is classified as treatment interruptions of TB?
A break in anti-tuberculosis treatment of atleast 2 weeks (during the initial phase)
or
missing more than 20% of prescribed doses
What should occur if a patient has a ‘treatment interruption’
treatment should be re-established as soon as possible to avoid;
relapse
drug resistance
