COMPLICATIONS of TB

PULMONARY COMPLICATIONS:

Massive hemoptysis
Cor pulmonale,
Fibrosis / emphysema
Atypical mycobacterial infection
Bronchopleural fistula
Lung / pleural calcification
Obstructive airway disease
Bronchiectasis


NON PULMONARY COMPLICATIONS:


Empyema
Laryngitis, Enteritis
Anorectal disease
T.B Pericarditis
T.B of spine (POTTS
disease)
Pleural effusion
Bones and joints T.B
T.B meningitis

MANAGEMENT OF TUBERCULOSIS
The most important factor in the
successful treatment of Tuberculosis
is continuous self administration of
drugs for 9 months.
Lack of patient compliance is the
major reason why the patient do not
respond to treatment.
Treatment should be started as soon
as AFB smear is positive in 2 lab
reports.

1. INITIAL PHASE (BACTERICIDAL PHASE)
Duration of this phase is 2 months.
Consists of 4 drugs:

1. Isoniazid + vit B6 = 5 mg/kg body wt.
2. Rifampicin = 10 mg/kg body wt.
3. Ethambutol = 15-25 mg/kg body wt.
OR Streptomycin = 15 mg/kg body wt.
4. Pyrazinamide = 15-30 mg/kg body wt.

2. CONTINUATION PHASE (STERILIZATION PHASE)

Duration of this phase is 7 months.
Consists of mainly 2 drugs:

1. Isoniazid + Vit B6
2. Rifampicin

In order to improve compliance. Special clinics are
used to supervise treatment directly.
To overcome this health problem a health care worker
physically observes the patient ingesting anti-
tuberculous drugs 3 times per week.
To reduce the number of tablets combination
preparations are used and dose is increased upto 50%.
DOTS Program












WHO Recommendations regarding TB Treatment


Category I
New sputum smear-positive pulmonary TB patients
Initial phase = 2HRZE Continuation phase = 4HR

Category II
Previously treated pulmonary sputum smear-positive patients
Initial phase = 2HRZES/1HRZE Continuation phase = 5HRE


Category III
New sputum smear-negative pulmonary TB patients
Initial phase = 2HRZE Continuation phase = 4HR
MAIN SIDE EFFECTS OF
ANTI-TUBERCULOUS DRUGS
1. ISONIAZID:
Peripheral neuritis, Hepatitis, Hypersensitivity
2. RIFAMPICIN:
Hepatitis, Fever, Thrombocytopenia, GIT disturbance
3. ETHAMBUTOL:
Retrobulbar optic neuritis, Hypersensitivity rash, Arthralgia
4. PYRAZINAMIDE:
Hepatitis, Gout, Hyperuricemia,
5. STREPTOMYCIN:
8
TH
nerve damage, Nephrotoxicity, Agranulocytosis

Treatment regimen for Patients with
Drug- induced hepatotoxicity

All drugs should be stopped at once. If TB is severe,
a non-hepatotoxic regimen consisting of streptomycin,
ethambutol and a fluoroquinolone should be started
OR
Another suggested regimen in such patients is a
2-month initial phase of daily streptomycin, isoniazid and
ethambutol, followed by a 10-month continuation phase of
isoniazid and ethambutol (2 SHE/10 HE).
SHE THERAPY
1. When patient uses single drug
2. Irregularly taking medicines
3. Not properly prescribed medicines
Treatment failure
When patients sputum culture remains positive after 3
months or AFB smear remains positive after 5 months.


When patient is resistant to more than one drug.
In these patients combination of 2
nd
line drugs are used.
2
nd
line drugs are less effective, more toxic and more
expensive.

2
nd
line drugs for T.B are:

1. Ofloxacin
2. Ethionamide
3. Cycloserine
4. Para aminosalicylic acid
5. Amikicin
6. Kanamycin
7. Capreomycin
1. Sputum AFB smear monthly until it becomes
negative
2. Chest X-ray initially and at the end of treatment
for comparison
3. Base line LFTs because hepatitis is major side
effect of anti-tuberculous drugs.
Prevention
Chemoprophylaxis
BCG vaccination at birth
Contact tracing