Tb Case Holding

Case memory -Ensures treatment compliance -Indirectly, this will translate to treatment success or cure -Poor treatment compliance may lam to the following outcomes oChronic infectious illness oDrug resistance oDeath Poor Case Holding 1. Inadequate drugs and poor drug distribution 2. Patients non-adherence 3. docs non-adherence 4. Low motivation of health workers SLU PPMD Unit Operations PTB hazard -Cough 2 weeks with or without the following oFever oHemoptysis oBack pains oWeight loss oEasy fatigability Refer to SLUPPMD whiz for sputum AFB calumniate v PTB YesNo vv TreatRefer to TBDC vSend back to quotering atomic number 101 -Importance of taking the drug -Role of treatment partner in the family -Possible side effects - lawful physical examination Classification of TB cases 1. Pulmonary TB a. dapple positive o2 (+) sputum AFB + radiographic abnormalities consistent with TB, OR o1 (+) sputum AFB + radiographic abnormalities consistent with progressive TB as determined by a mendelevium, OR o1 (+) sputum AFB + sputum culture (+) for MTB b. Smear negative o 3 (-) sputum AFB with radiographic abnormality consistent with active PTB, AND ono response to a course of antibiotics, AND oTBDC decides to treat the persevering . Extra-Pulmonary TB (EP) a. A tolerant with at least one mycobacterial smear/culture positive from an extra-pulmonary site, OR b. A patient with histological &/or clinical evidence consistent with active extra-pulmonary TB and there is a decision by the TBDC to treat the patient with anti-TB drugs. -Note All EP cases shall undergo DSSM prior to treatment Types of TB Cases -New no Tx or 2 months - interference failure still (+) on the fifth month -Other became (+) on 2nd month interrupted Tx but smear (-) Recommended Category of Treatment Regimen CategoryType of TB PatientTB Treatment RegimenIntensiveContinuation INew smear (+) PTB New smear (-) PTB with extensive parenchymal lesion on CXR (TBDC) EPTB and severe concomitant HIV dise ase2HRZE4HR IITreatment failure, RAD, relapse, other2HRZES/ HRZE5HRE IIINew smear (-) PTB with stripped-down parenchymal lesions on CXR (TBDC)2HRZE4HR IVChronic (still smear (+) after supervised re-treatment)Refer to specialized facility or DOTS plus center Directly Observed Treatment (DOT) -Success depends on having a responsible treatment partner. any of the following could serve as a treatment partner 1. DOTS facility staff much(prenominal) as accoucheuse or the nurse 2.A trained community member such as the BHW, local government official or former TB patient. Schedule of DSSM Follow-up (Categories I and III) Schedule of DSSM follow-upCategory I (2HRZE/4HR)Category III (2HRZE/4HR) Regular treatment Regular1 month extension Towards the end of 2nd monthYes (if positive)Yes Towards the end of third month(if negative)Yes Towards the end of 4th monthYes Towards the end of 5th monthYes source of 6th monthYes Beginning of 7th monthYes Schedule of DSSM Follow-up (Category II) Schedul e of DSSM follow-upCategory II (2HRZES/HRZE/5HRE) Regular Treatment1 month extension Towards the end of 3rd monthYes (if positive)Towards the end of 4th month(if negative)Yes Towards the end of 5th monthYes Towards the end of 6th monthYes Beginning of 8th monthYes Beginning of 9th monthYes Guide in Managing Adverse Reactions to Anti-TB drugs Adverse ReactionsDrug(s) probably responsibleManagement Minor GI intoleranceRHGive meds at HS or small meals Mild skin reactionsAnyGive antihistamines Orange/red color urineRifampicinReassure the patient Pain at the injection siteStreptomycinWarm compress. Rotate sites. Burning sensation in the feet due to neuropathyINHPyridoxine 100-200 mg/day for treatment 10 mg for bar Arthralgia due to hyperuricemiaPZAGive ASA/NSAIDFlu-like symptomRifampicinGive antipyretics Major Severe skin rashAny (especially Streptomycin)Discontinue anti-TB drugs and refer to DOTS medico JaundiceRHZDiscontinue anti-TB drugs and refer to DOTS physician Impairment of vis ual acuity optic neuritisEMBDiscontinue EMB and refer to ophthalmologist Hearing impairmentStreptomycinDiscontinue streptomycin and refer to DOTS physician Psychosis and convulsionINHDiscontinue INH and refer to DOTS physician Thrombocytopenia, anemia and shockRifampicinDiscontinue anti-TB drugs and refer to DOTS physician