Health teaching for tuberculosis patients

Health teaching of patients with tuberculosis treatmentEllyzawati HussinWad Multidisiplin 1ST OKTOBER 20151430-1630UNIT LAKTASI, TINGKAT 1, KOMPLEKS WANITA.

Aims of TreatmentThe aims of treatment of tuberculosis are:to cure the patient and restore quality of life and productivity;to prevent death from active TB or its late effects;to prevent relapse of TB;to reduce transmission of TB to others;to prevent the development and transmission of drug resistance.10/1/20152When starting treatmentMust give health educationNature of the diseaseNecessity of strict compliance with the prolonged treatmentRisks of defaulting treatmentSide effects of medicationRisks of transmission and need for isolationTypes of tuberculosisPulmonary tuberculosis-lung

Extrapulmonary tuberculosis-skin-ear, nose, eye-bone-meningitis-lymph nodesExtraPulmonary TBmonthSteroidCommentLymph node6-9Pleural disease6-9CNS including meningitis9-12Recommended Use streptomycin instead of EthambutolDisseminated (including Military) disease6-9Test fo CNS involvementPeritoneal6-9Bone and joint6-9If CT/MRI shows active spinal cord involvement treat as CNS TBPericarditis6-9Recommended Genitourinary6-9Treatment for new casesRecommendation:2 MONTHS Intensive -2EHRZ (TAB AKURIT 4)4 MONTHS Maintenance -4HR(TAB AKURIT)Regimen should contain 6 month of RifampicinRifampicin should be rounded to higher recommended dose if toleratedIf Ethambutol is CI, Streptomycin can be substitutedTreatment for new cases7 MONTHS Maintenance IF:Slow or suboptimal responseSputum cultures still positive after 2 months of intensiveNo PZA in intensive phase Dosage of First Line AntiTB DrugsDRUGRecommended doseDaily3 times per weekDose (range) in mg/kg body weightMaximum in mgDose (range) in mg/kg body weightDaily maximum in mgIsoniazid (H)5(4-6)30010(8-12)900Rifampicin (R)10(8-12)60010(8-12)600Pyrazinamide (Z)25(20-30)2000Refer specialistRefer specialist

Ethambutol (E)15(15-20)1600Refer specialist

Refer specialist

Streptomycin (S)15(12-18)1000Refer specialist

Refer specialist

Optimal duration of treatmentFor sputum positive AFB recommended minimum duration of 6 monthsWith shorter duration of Rifampicin associated with Higher risk of failure andRelapse andAcquired drug resistanceNew patient with PTB should receive daily intensive regimen followed by daily maintenance regimen

Thrice weekly maintenance regimen can be considered under direct observation(DOTS)

Not recommended twice weekly regimen as missing one dose means patient receives half total dose for that week

Fixed Dose CombinationReduce risk of non compliance and consequently improve effectiveness of therapy

2 FDC available in MOH Formulary4 drugs combination: Isoniazide 75mg, Rifampicin 150mg, Pyrazinamide 400mg and Ethambutol 275mg tablet (AKURIT -4)

3 drug combination: Isoniazide 75mg, Rifampicin 150mg and Pyrazinamide 400mg tablet Recommended dosages for FDCBODY WEIGHTDOSE30-37 kg2 tab od38-54 kg3 tab od55-70 kg4 tab od>70 kg5 tab odFDC are preferred to separate-drugs combination for treatment of TB

In patient who develop toxicity, intolerance or CI to specific component drugs, FDC can be substitutes with separate-drug regimensTreatment Flow ChartINTENSIVE PHASE

SEE DOCTOR 4/52(FBC/RP/LFT 1/52 BEFORE TCA)

SEE DOCTOR ON DAY 56 ON ANTI TB (2/12)FBC/RP/LFT/SPT AFB/CXR 1/52 SPUTUM MTB C&S BEFORE TCA*sputum D/S X3,sputum culture AFB, liver function test, renal profile blood sugar, pregnancy test, visual test and HIV if indicated.

14Treatment Flow ChartMAINTENANCE PHASE

SEE DOCTOR 2/12 3/12(FBC/RP/LFT- 1/52 BEFORE TCA)

DURATION DOSE6/12 126 DOSES9/12 217 DOSES1 YEAR 309 DOSES

CXR ON 2ND MONTH AND END OF RX MAINTENANCE PHASE PTB

15Side effect of TB drugsMinor Major Side effectHow to overcomeTea coloured urinTake plenty of water 2-3 litre/dayHeadache Take a good rest, possibly take pcmNausea and vomitingTake a good rest, possibly see a DrItchiness all over bodyIf possible to take antihistamineSide effect How to overcomeYellowish eye/jaundiceDizziness Palpitationredness or blister of skinSwollen of body eg: lips,hand or footSevere diarrhea/ vomiting STOP TAKING MEDICATION

SEEK FOR YOUR DOCTOR

Bring along TB Treatment book & appointment card

Call DOTS 2389( working hours)Straight away go to nearest hospital/ emergency.Symptom based approach to managing side effects of anti TB drugs Side effectDrug (s) probably responsibleManagementSkin rash with or without itchingStrepromycinIsoniazid Rifampicin Pyrazinamide Stop anti TB drugsDeafness (no wax on otoscopy)Streptomycin Stop streptomycin Dizziness (vertigo and nystagmus) StreptomycinStop streptomycinJaundice (other causes excluded), hepatitisIsoniazid PyrazinamideRifampicin Stop anti TBConfusion (suspect drug-induced acute liver failure if there is jaundice)Most anti TB drugsStop anti TBSymptom based approach to managing side effects of anti TB drugs Side effectDrug (s) probably responsibleManagementVisual impairment (other causes excluded)Ethambutol Stop EthambutolShock,purpura, acute renal failureRifampicinStop RifampicinDecreased urine outputStreptomycinStop streptomycinAnorexia, nausea, abdominal painIsoniazid PyrazinamideRifampicin Give drugs with small meals or just before bedtime and advice patient to swallow pills slowly with small sips of water. If sx persist or worsen or there is protracted vomiting or any sign of bleeding consider side effect to be major and referJoint painsPyrazinamide Aspirin or NSAID or PCMSymptom based approach to managing side effects of anti TB drugs Side effectDrug (s) probably responsibleManagementBurning , numbness or tingling sensation in the hands or feetIsoniazid Pyridoxine 50-75mg dailyDrowsiness Isoniazid Reassurance. Give drugs before bedtimeOrange / red urineRifampicinReassurance. Patient should be told when starting treatment that this may happen and is normalFlu syndrome (fever, chills, malaise, headache, bone pain)Intermitent dosing of Rifampicin Change from intermittent to daily Rifampicin administrationSummary of Adverse Drug Reaction to Anti TB Drugs1st line drugcommonuncommonrareIsoniazidHepatitisHypersensitivityP NeuropathyGiddinessConvulsionOptic neuritisH AnemiaA AnemiaAgranulocytosislupoid reactionAthralgia GynaecomastiaRifampicinHepatitis C hypersensitivityT PurpuraFebrile reactionFlu syndromeARFH AnemiaSummary of Adverse Drug Reaction to Anti TB Drugs1st line drugcommonuncommonrarePZAAnorexia Nausea Flushing C hypersensitivityHepatitisVomiting Athralgia S anemiaPhotosensitivity EthambutolR NeuritisAthralgia HepatitisC HypersensitivityP NeuropathyStreptomycinC HypersensitivityGiddiness NumbnessTinnitus Vertigo Ataxia Deafness Renal damage A Anemia Agranulocytosis D.O.T.SDIRECTLY OBSERVATION TREATMENT SHORT-COURSE UNDER SUPERVISIONHow to take medicationTake with empty stomachDo not take any food 1 hour after taking medicationIf patient had gastritis, take small portion of food such as slice of bread then take a medicine 1 hour later.one of family member must be observe/witness patient when taking TB drugs, signiture in treatment book.HEALTH ADVICEPTB patients should wear a mask everyday for 2 weeks. Keep using mask in plastic before disposal. Mask should be changed everyday.Open the windows and the curtains in the morning for good ventilation.No need to separate dishes.Take balanced food. Get enough rest and avoid crowded places.Reference To The Eye Clinic / Screening For Family MembersPatients should be referred to an eye clinic while taking Ethambutol drugs to detect symptoms such as farsightedness, nearsightedness and and colour blindness.If there is a matter before the appoinment date, please contact DOTS to get an appointment in advance.Each family member who close to the patient MUST do tuberculosis screening at a RUKA @ nearest Klinik Kesihatan.Appointment of Medication in DOTSMedication should only be taken in DOTS Clinic.Make sure enough supply of medicines. If running out of medication on holidays, please come on weekdays.Avoid coming on Wednesday and Friday to avoid a long waiting hour (special clinics).Bring along 10E book (treatment book) and appointment card.Medical supplies will be provided for 2 weeks @ 3 weeks depending on the appointment date.Doctors AppointmentsAfter seeing the doctor please came back to DOTS Clinic for medication.Please bring TB Treatment Chart along.Please inform us if stop treatment.TB treatment is free of charge.MANTOUX TEST & READING

Types of tbis form

NOTIFICATION FORM & TB TREATMENT CHARTNOTIFICATION FORM AND TB TREATMENT CHART FORM29

TBIS 10A-1 & TBIS 10C-3Types of tbis form

Types of tbis form

TBIS 10D & TBIS 10E

Types of tbis form

TBIS 10F & TBIS 10G

Types of tbis form

TBIS 10-I & TBIS 10K