tuberculosis

Question 1

The standard treatment of active tuberculosis is completed in two phases, what are those two phases ?

Answer 1

initial phase using four drugs and a continuation phase using two drugs,

Question 2

Which antibiotics are used in the initial phase of tuberculosis and for how long ? RIPE

Answer 2

rifampicin,
ethambutol hydrochloride, 
pyrazinamide
isoniazid (with pyridoxine hydrochloride)
2 months

Question 3

Which antibiotics are offered in continuation phase when treating TB and for how long ?

Answer 3

rifampicin and isoniazid (with pyridoxine hydrochloride) for a further 4 months

Question 4

What are the key counselling points for rifampicin ?

Answer 4

rifampicin discolours soft contact lenses, colour urine: red/orange
Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food
seek immediate medical attention if symptoms such as persistent nausea, vomiting, malaise or jaundice develop.

Question 5

What are the common/very common general side effects of rifampicin ?

Answer 5

Nausea; thrombocytopenia; vomiting

Question 6

What s/e may occur with intermittent rifampicin therapy ?

Answer 6

influenza-like symptoms (with chills, fever, dizziness, bone pain), respiratory symptoms (including shortness of breath), collapse and shock, haemolytic anaemia, thrombocytopenic purpura, and acute renal failure.

Question 7

What are the key counselling points for isoniazid (enzyme inhibitor) ?

Answer 7

1. seek immediate medical attention if symptoms such as persistent nausea, vomiting, malaise or jaundice develop.
2. Avoid tyramine-rich foods (such as mature cheeses, salami, pickled herring, Bovril®, Oxo®, Marmite® or any similar meat or yeast extract or fermented soya bean extract, and some beers, lagers or wines) or histamine-rich foods (such as very mature cheese or fish from the scromboid family (e.g. tuna, mackerel, salmon)), as tachycardia, palpitation, hypotension, flushing, headache, dizziness, and sweating reported.
3. Take pyridoxine to prevent peripheral neuropathy
4. Take 30 to 60 minutes before food

Question 8

When would pyrizinamide be contraindicated ?

Answer 8

Acute attack of gout (in adults)

Question 9

what are the key counselling points for pyrazinamide ?

Answer 9

seek immediate medical attention if symptoms such as persistent nausea, vomiting, malaise or jaundice develop.

Question 10

When would ethambutol be contraindicated ?

Answer 10

Optic neuritis; poor vision

Question 11

What are the common side effects of ethambutol ?

Answer 11

Hyperuricaemia; nerve disorders; visual impairment
Ocular toxicity is more common where excessive dosage is used or if the patient’s renal function is impaired. Early discontinuation of the drug is almost always followed by recovery of eyesight.

Question 12

What are the key counselling points with ethambutol ?

Answer 12

patients should be advised to discontinue therapy immediately if they develop deterioration in vision and promptly seek further advice.