Treatment• Bed rest doesn’t affect outcome• Hospitalisation:

– Ill, smear positive, highly infectious patients– Esp in multi-drug resistant TB

• Continuous self-admin of drugs for 6 months vital for successful Rx– Lack of compliance 5% pts unresponsive to Rx– Resistance to anti-TB drugs increasing

• Isoniazid resistance 4-6%• Multidrug resistance 1%

• Before treatment:– Test FBC, liver, and renal function

• Need to alter dosages in pts with liver/renal failure– Test colour vision & acuity

• Ethambutanol can cause (reversible) ocular toxicity

Treatment• 6 months

– Rifampicin 600-900 mg, daily– Isoniazid 300 mg daily– Pyrazinamide 2.5g, 3/week

• First 2 months

– Ethambutanol 30 mg/kg 3/week• First 2 months

• Longer regimen:– For bone TB (9 months), tuberculosis meningitis (1yr)

• NEVER use monotherapy – Except when using Isoniazid for latent TB Rx

• DOTS: Directly Observed Therapy (short-course)– WHO incentive, to improve detection and compliance– DOT plan: treating physician/TB nurse– Bi-weekly, thrice-weekly treatment instead of daily

Side Effects• Rifampicin:

– Hepatitis– Small rise in AST acceptable– Stop if bilirubin rises– Orange discolouration of urine & tears– Inactivation of the Pill

• Isoniazid– Hepatitis– Neuropathy– Pyridoxine deficit– Agranulocytosis

• Ethambutanol– Optic neuritis (colour vision fist to deteriorate)– Pyrazinamide: Hepatitis– Athralgia (CI: gout, prophyria)

Resistance

• Seen in non-compliant pts• MDR (multi-drug resistance)

– High mortality (esp in HIV pts)• Use at least 3 drugs to which organism is sensitive

• Follow-up– Patients should be seen regularly for duration of chemotherapy– Once more after 3 months to check for relapse

• Chemoprophylaxis:– Pts with x-ray xhanges compatible with TB, but about to

undergo immunosuppresive long-term Rx (ie dialysis)– Isoniazid 300-450 mg/day