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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)
Click here to send remarks, suggestions, corrections
Click here to go to the protocols table
_______________________________________
paul yves wery - aidspreventionpro@gmail.com
aids-hospice.com & prevaids.org & stylite.net