Tb Case Holding

Case retentiveness -Ensures give-and-take accordance -Indirectly, this will translate to treatment success or cure -Poor treatment compliance may lead to the adjacent outcomes oChronic infectious illness oDrug resistance oDeath Poor Case Holding 1. incompetent drugs and poor drug distribution 2. Patients non-adherence 3. Physicians non-adherence 4. Low motivation of wellness workers SLU PPMD Unit Operations PTB Suspect -Cough 2 weeks with or without the following oFever oHemoptysis oBack pains oWeight loss oEasy fatigability Refer to SLUPPMD accordance for sputum AFB smear v PTB YesNo vv TreatRefer to TBDC vS annul back to denotering physician -Importance of taking the drug -Role of treatment partner in the family -Possible side effects -Regular physical examination Classification of TB cases 1. Pulmonary TB a. fleck positive o2 (+) sputum AFB + radiographic abnormalities consistent with TB, OR o1 (+) sputum AFB + radiographic abnormalities consistent with officious TB as d etermined by a physician, OR o1 (+) sputum AFB + sputum refinement (+) for MTB b. Smear negative o 3 (-) sputum AFB with radiographic abnormality consistent with alive(p) PTB, AND ono response to a assembly line of antibiotics, AND oTBDC decides to treat the patient role . Extra-Pulmonary TB (EP) a. A patient 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 preceding to treatment Types of TB Cases -New no Tx or 2 calendar months -Treatment failure still (+) on the 5th 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 a nd severe concomitant human immunodeficiency virus disease2HRZE4HR IITreatment failure, RAD, relapse, other2HRZES/ HRZE5HRE treyNew smear (-) PTB with minimal parenchymal lesions on CXR (TBDC)2HRZE4HR IVChronic (still smear (+) after supervised re-treatment)Refer to specialized facility or DOTS sum 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 such as midwife or the nurse 2.A trained community member such as the BHW, local presidential term 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 3rd month(if negative)Yes Towards the end of quaternate monthYes Towards the end of 5th monthYes Beginning of 6th monthYes Beginning of 7th monthYe s Schedule of DSSM Follow-up (Category II) Schedule 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 small-scale 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/ mean solar day for treatment 10 mg for prevention Arthralgia due to hyperuricemiaPZAGive ASA/NSAIDFlu-like symptomRifampicinGive antipyretics Major Severe skin rashAny (especially Streptomycin)Discontinue anti-TB drugs and refer to DOTS physician Jaund iceRHZDiscontinue anti-TB drugs and refer to DOTS physician Impairment of visual acuity optic neuritisEMBDiscontinue EMB and refer to ophthalmologist audience 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