31-§2-Tuberculosis

Treatment for special contexts:

1.If no sputum tests are available

2.If well-organized follow-up will be difficult

3.If close to death and/or severe cachexia

4.If patient is untrustworthy/untruthful (non-compliance)

5.If present treatments are not working & it is not possible to refer

Drugs available:

1: If not able to check sputum and/or poor ward organization (not able to check if patients receive & take all drugs...which is common!)

If patient stopped taking drugs on his/her own (first time):

2: If patient is not reliable or truthful (non-compliant)

If a patient stops taking drugs by him/herself twice for more than 3 days without a strong excuse... stop treatment.  A hospice must not be a place to select and promote resistant germs.

3: If present treatments are not working and it is not possible to refer

If no better, consider it is MAC and accept an inability to treat…

4: If the patient's condition is "too serious" to take drugs

- Consider ceasing treatment because TB drugs can sometimes make patients' lives very uncomfortable or even cause more suffering than the TB infection itself.  (Sometimes stopping TB drugs may give a patient a few extra months of comfortable living)

- Consider ceasing treatment in situations where the digestive tract of a cachectic patient does not fully absorb drugs -- which can be a cause of drug resistance

...It is better to stop TB drugs for patients who are close to death or in very bad condition ('tired intestine") (xxx001) (xxx005) (xxx008) (xxx009).