 |
Objectives
- Disseminate info on TB in India
- Improve care of TB patients in India
- Enable doctors and NGO's interested in TB control
to interact
|
DRUG RESISTANCE IN TUBERCULOSIS:Prevention
In new cases
The best prevention is to give each new case of sputum positive pulmonary tuberculosis an effective regimen of short course chemotherapy(6 months or 8 months)with 4 drugs(isoniazid,rifampicin,pyrazinamide and ethambutol or streptomycin)during at least the first 2 months.
It is important to satisfy oneself that the patient is indeed a new case by careful history,obtaining all previous medical records,and if none is available careful questioning regarding:
- Previous respiratory illness
- whether any sputum or Xray examinations were undertaken in the past.
- Nature of drugs taken and duration;patient's memory can be jogged by showing different antitubercular drugs
In old cases
In the group of tuberculosis patients treated with one or several courses of chemotherapy and who remain sputum positive (by smear and or culture),three subpopulations can be observed:
- patients excreting bacilli still susceptible to all antituberculosis drugs
- patients excreting bacilli resistant to at least isoniazid but still susceptible to rifampicin
- patients excreting bacilli resistant to at least isoniazid and rifampicin
The WHO recommended regimen 2SHRZE/HRZE/5HRE is likely to give good results in patients 1 and 2 above
In patients who have failed after the first course of chemotherapy
- Make an intelligent assessment whether the patient took the prescribed rugs in the past as per the recommendations.
- Carefully select the combination of drugs depending on culture and sensitivity results wherver available
- When culture sensitivity studies are not possible ,then continue with the old regimen and add 2 or more new drugs.Otherwise stop previous treatment and start with three or four new drugs
- Avoid addtition of one drug to a failing regimen.It only helps to produce bacilli resistant to each single drug added.
- Consider surgical treatment if possible
- Therapy should be continued for 24 months after achieving culture negativity
Disclaimer Altough
every precaution has been taken in the preparation of this site,the
author assumes no responsiblity for errors or omisssions.Neither is
any liability assumed for damages resulting from the use of the
information contained herein