Management of Tuberculosis and Drug-Resistant TB

Management of Tuberculosis Dr. Uttam Kumar Dasgupta MBBS (Cal) MD (Cal, Chest)

Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Statistics ,[object Object],[object Object],[object Object],[object Object]

Principle of standard short course therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Aims of treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]

Protocol of treatment with dose ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Side effect profile ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Contd… ,[object Object],[object Object],[object Object],[object Object]

Contd… ,[object Object],[object Object],[object Object]

Adverse effects with management ,[object Object],[object Object],[object Object],Cs, H AG, FQ, Eto, Pto Peripheral neuropathy ,[object Object],[object Object],[object Object],Cs H, FQ Seizures Management Drugs responsible Adverse effect

Contd… 1. Antipsychotics Cs FQ, H, Eto, Pto Depression ,[object Object],[object Object],[object Object],Cs, H FQ, Eto, Pto Psychotic reactions Management Drugs responsible Adverse effects

Contd… PPI / Antiemetics Eto, Pto, PAS R Gastritis Thyroxine PAS, Eto, Pto Hypothyroidsm Change to Cm AG Clr Hearing loss Management Drugs responsible Adverse effects

Contd… Stop E Optic neuritis NSAID Dose / Stop Z Arthralgia Replace Cm AG Electrolyte disturbances (K, Mg ) Use Cm Give bi / tri wkly. AG Renal toxicity Management Drugs responsible Adverse effects

Revised National Tuberculosis Control Programme (RNTCP) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Categorization of TB pts. for registration on diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Standardized treatment protocol ,[object Object],[object Object],[object Object],[object Object]

DOTS ,[object Object],[object Object],[object Object]

Contd… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Sputum Categorization 100 - NEG Nil 200 No / 200 Scanty 1 – 9 AFB / 100 OIF 100 1+ POS 10 – 99 AFB / 100 OIF 50 2+ POS 1 – 10 AFB / OIF 20 3+ POS >10 AFB / OIF No. of fields Grading Results If slide has

Outcome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Debates ,[object Object],[object Object],[object Object]

TB & Diabetes Mellitus ,[object Object],[object Object],[object Object],[object Object],[object Object]

Points to remember in TB + DM ,[object Object],[object Object],[object Object],[object Object],[object Object]

TB & HIV ( The Deadly Duo ) ,[object Object],[object Object],[object Object],[object Object]

Issues in HAART – ATD ,[object Object],[object Object],[object Object]

Contd… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Overlapping adverse event profile - ZDV CTMX Valganciclovir Bone marrow dysplasia RBT, R Pancytopenia - d4T, ddl & ddc - - H & E Peripheral neuropathy + in pts. With chr. Viral hepatitis NVP, all PI CTMX - ZRH, RBT Hepatitis - Ddl - - E, RBT Ocular Effects + Pancreatitis or Intra – abd. Adenitis ZDV, r, IDV - Do - Other opp infections - Do - Nausea Vomiting - NVP, EVP, ABC CTMX Folliculitis ZRH, RBT Skin Rash IRS ARV drugs Medication other than ARV HIV ATT Possible Causes Adverse Effects

Drug – drug interaction ,[object Object],[object Object],[object Object],[object Object],[object Object]

IRS ,[object Object],[object Object],[object Object],[object Object]

BCG & HIV ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

MDR TB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Basic principles of Tt. Of MDR TB ,[object Object],[object Object],[object Object],[object Object],[object Object]

Contd… ,[object Object],[object Object],[object Object],[object Object],[object Object]

Drugs used in MDR TB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Doses 10 – 12 g. 10 g. 8 g. 150 m/K PAS 750-1000 mg. 750 mg. 500 mg. 15-20m/K Cs 750-1000 mg. 750 mg. 500 mg. 15-20m/K Eto / Pto 400 mg. 400 mg. 400 mg. 7.5–10m/k Mfx / Gfx 750-1000 mg. 750 mg. 750 mg. 7.5–10m/k Lfx 800-1000 mg. 800 mg. 800 mg. 15–20m/k Ofx - - - 15–20m/k AG > 70 Kg. 51-70 Kg. 33–50 Kg. < 33 Kg. Drugs

Case 1 ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Case 2 ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Case 3 ,[object Object],[object Object],[object Object],[object Object]

Management of contacts of MDR TB patients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

XDR TB (Extensively drug resistant TB) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Actions to prevent XDR TB ,[object Object],[object Object],[object Object],[object Object]

DOTS PLUS & Green Light Committee ,[object Object],[object Object]

TB & Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management of latent TB – Indications of Tt. Silicosis / DN / malignancy Chr. immunosupression Lab personnel Prior TB (fiibrosis) Residents & employees of high risk setup. Recent contact No risk persons Immigration HIV +ve 15 mm. induration 10 mm. induration 5 mm. induration

Treatment of latent TB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Toxicity with Tt. of latent TB ,[object Object],[object Object]

Problems with treatment of latent TB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Newer drugs in TB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Contd… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Contd… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management of Tuberculosis and Drug-Resistant TB

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Management of Tuberculosis and Drug-Resistant TB