Pharmacological Treatment of Pulmonary Tuberculosis


Specifically, TB treatment aims to:
·         Cure the patient and restore quality of life and productivity.
·         Prevent relapse of TB.
·         Reduce transmission of TB to others.
·         Prevent the development and transmission of drug-resistant tubercle bacilli.
·         Prevent death from active TB or its late effects.
Recommended daily doses of first-line anti-TB drugs  
New
Initial phase; Rifampicin + Isoniazid + Pyrazinamide and Ethambutol in fixed dose (RHZE) for 2 months
Continuation phase; Rifampicin + Isoniazid (RH) for 4 months
Retreatments
Initial phase; Streptomycin+ Rifampicin + Isoniazid + Pyrazinamide and Ethambutol for 2months then RHZE for 1months
Continuation phase; Rifampicin + Isoniazid+ Ethambutol (RHE) for 5 months
Source: Manual for the Management of Tuberculosis and Leprosy (6th ed) National Tuberculosis and Lepros y Programme, Ministry of Health and Social Welfare
The following shall be considered in treatment of TB patients:
·         The most serious problem with TB therapy is nonadherence to the prescribed regimen. The most effective way to ensure adherence is with directly observed therapy (DOT)
·         The oral drugs should preferably be given on an empty stomach in a fixed dose combination 

Treatment of Tuberculosis in Special Cases
Consideration is needed when handling a patient with TB/HIV co-infection;
·         Start ART for all TB patients living with HIV irrespective of CD4 counts; Treat TB first and start ART as soon as possible, preferably within two weeks of initiating treatment
·         If CD4 count is less than 50 cells/mm3; Treat TB first and start ART within the first two weeks of initiating TB treatment
·         Already on ART at TB diagnosis; Treat TB and replace nevirapine with efavirenz

Doctor Sitting in Front of His Desk
References

Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6th Ed). New York, NY: McGraw-Hill.

DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008): Pharmacotherapy: A Pathophysiologic Approach (7th ed): New York, NY: McGraw-Hill.

Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011) Principles & Practice Study Guide: A Case-Based Care Plan Approach: New York, NY: McGraw-Hill.

Schwinghammer TL, Koehler JM (2009) Pharmacotherapy Casebook: A Patient-Focused Approach (7th ed): New York, NY: McGraw-Hill.

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