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31-§1-Tuberculosis
Treatment if patients are well
controlled & AFB test is available:
Drugs available:
|
Drug /patient
weight
|
20kg
|
<30kg
|
30-39 kg
|
40-49 kg
|
>50 kg
|
|
H= Isoniazid (INH)
|
200mg
|
10mg/kg
|
300 mg
|
300 mg
|
300 mg
|
|
R= Rifampicin (RIF)
|
2-300mg
|
10-15mg/kg
|
300 mg
|
450 mg
|
600 mg
|
|
Z= Pirazinamide (PZA)
|
3-600mg
|
15-30mg/kg
|
1000 mg
|
1500 mg
|
2000 mg
|
|
E= Ethambutol (EMB)
|
3-500mg
|
15-25mg/kg
|
600-800 mg
|
1000-1200mg
|
1200-1500 mg
|
|
S= Sreptomycin
|
300mg
|
15mg/kg
|
500 mg
|
750 mg
|
1000 mg
|
There are 3 possible situations:
·
§1 - Patient takes drugs regularly
·
§2 - Patient does not take drugs regularly
(because vomiting, confused, depressed, non-compliant etc.)
·
§3 - Patient's condition "too serious"
to take drugs.
If the organization of the ward or case histories or follow-ups of patients
are not perfect, it is better to go to protocol TB 31-§2 (a "stricter" but safer policy because it
can control problems of resistant strains of TB)....
§1-
Patients must take drugs regularly!
|
Treatment category
|
Treatment…
|
…For patients who are:
|
|
Cat1
|
2months HRZE
|
4months HR
|
- Sputum
test (+)
- Sputum
(–) but severe symptoms
- Extra-pulmonary
TB with heavy symptoms
|
|
If sputum positive after second month, give 3
months HRZE
|
|
Cat2
|
2months HRZES +1month
HRZE
|
5months HRE
|
- Relapse
- Failure
of former treatment
- Patient
who stopped taking drugs by himself >2 months and sputum+ (see specific
protocol)
|
|
If sputum positive after the third month, give 2 months HRZE
|
|
Cat3
|
2months HRZ
|
4months HR
|
- Sputum
(–) and mild symptoms
- Extra-pulmonary
TB with mild symptoms
|
|
Cat4
|
Second line drugs… only
a specialized TB center can order these drugs!!!
|
(This table
is extracted, adapted and translated from the Thai TB policy)
§2- The patient stopped taking drugs on his own.
If patient has already taken
the Category 1 drugs
|
Began treatment
|
Stopped taking
the drugs
|
Must check sputum
again?
|
If result is...
|
How to treat
|
|
<1 month ago
|
<2 weeks ago
|
No
|
|
Continue categ.
1
|
|
2-8 weeks ago
|
No
|
|
Start cat1again
|
|
>8 weeks ago
|
Yes
|
+
|
Start cat1
again
|
|
-
|
Continue cat1
|
|
1-2 months ago
|
<2 weeks ago
|
No
|
|
Continue cat1
|
|
2-8 weeks ago
|
Yes
|
+
|
Cat1+1month
|
|
-
|
Continue cat1
|
|
>8 weeks ago
|
Yes
|
+
|
Start cat2
|
|
-
|
Continue cat1
|
|
>2 months ago
|
<2 weeks ago
|
No
|
|
Continue cat1
|
|
2-8 weeks ago
|
Yes
|
+
|
Start cat2
|
|
-
|
Continue cat1
|
|
>8 weeks ago
|
Yes
|
+
|
Start cat2
|
|
-
|
Continue cat1
|
If patient has already taken
the category 2 drugs
|
Began treatment
|
Stopped taking
the drugs
|
Must check sputum
again?
|
If result is...
|
How to treat
|
|
<1 month ago
|
<2 weeks ago
|
No
|
|
Continue cat2
|
|
2-8 weeks ago
|
No
|
|
Start cat2
again
|
|
>8 weeks ago
|
Yes
|
+
|
Start cat2
again
|
|
-
|
Continue cat2
|
|
1-2 months ago
|
<2 weeks ago
|
No
|
|
Continue cat2
|
|
2-8 weeks ago
|
Yes
|
+
|
Cat2+1month
|
|
-
|
Continue cat2
|
|
>8 weeks ago
|
Yes
|
+
|
Start cat2
again
|
|
-
|
Continue cat2
|
|
>2 months ago
|
<2 weeks ago
|
No
|
|
Continue cat2
|
|
2-8 weeks ago
|
Yes
|
+
|
Start cat2
again
|
|
-
|
Continue cat2
|
|
>8 weeks ago
|
Yes
|
+
|
Start cat2
again
|
|
-
|
Continue cat2
|
If patient has already taken
the category 3 drugs
|
Began treatment
|
Stopped taking
the drugs
|
Must check sputum
again?
|
If the result
is...
|
How to treat
|
|
<1 month ago
|
<2 weeks ago
|
No
|
|
Continue cat3
|
|
2-8 weeks ago
|
No
|
|
Continue cat3
|
|
>8 weeks ago
|
Yes
|
+
|
Start cat1
|
|
-
|
Continue cat3
|
|
1-2 months ago
|
<2 weeks ago
|
No
|
|
Continue cat3
|
|
2-8 weeks ago
|
Yes
|
+
|
Start cat2
|
|
-
|
Continue cat3
|
|
>8 weeks ago
|
Yes
|
+
|
Start cat2
|
|
-
|
Continue cat3
|
|
>2 months ago
|
<2 weeks ago
|
No
|
|
Continue cat3
|
|
2-8 weeks ago
|
Yes
|
+
|
Start cat2
|
|
-
|
Continue cat3
|
|
>8 weeks ago
|
Yes
|
+
|
Start cat2
|
|
-
|
Continue cat3
|
(These
tables are extracted, adapted and translated from the Thai TB policy)
§3- The patient's condition is "too serious" to take
drugs.
- Make this choice in certain serious cases because TB drugs can sometimes
make patients' lives very uncomfortable or even cause suffering worse than the
TB infection itself. (Sometimes stopping TB drugs may give a patient a
few extra months of comfortable life)
- Make this choice in situations where the digestive tracts of cachectic patients
do 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 a very bad condition ('tired intestine") (xxx001) (xxx005) (xxx008) (xxx009).
Symptomatic care:
(see "12-Dyspnea Polypnea",
"23-Pain", "18-Last Step", "9-Dexa"...)
·
DYSPNEA:
§
O2, dexamethasone
·
COUGHING AND SPUTUM
(danger for other patients!)
§
"Dry" secretions with
Buscopan 1-2tabs 3-4x/day
§
Strong anti-tussive drugs: codeine
syrup1-2 tabs 3-4x/day
·
BRONCHOSPASM:
§
Ventolin 1-2tabs 3x/day, +/- theophylline 200mg 1-2tabs
3x/day +/- dexa
***
A good TB flowchart
form for use in the case history of patients allows close
Monitoring of
treatment, which is crucial for a successful result:
To see an example
of Category 1 form CLICK HERE
To see how to
fill in the Category 1 form CLICK HERE
To download
the 3 forms (wmf format) CLICK
HERE
To download
the 3 forms (cdr format) CLICK HERE
("cdr"
and "wmf" format can be resized without loss of quality.)
(The 3 forms
are adapted for photocopy in black and white)
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