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ALL / Infectious Diseases
Tuberculosis: management
Tuberculosis: management
The standard therapy for treating active tuberculosis is:Initial phase - first 2 months (RIPE)
- Rifampicin
- Isoniazid
- Pyrazinamide
- Ethambutol (the 2006 NICE guidelines now recommend giving a 'fourth drug' such as ethambutol routinely - previously this was only added if drug-resistant tuberculosis was suspected)
Continuation phase - next 4 months
- Rifampicin
- Isoniazid
The treatment for latent tuberculosis is 3 months of isoniazid (with pyridoxine) and rifampicin OR 6 months of isoniazid (with pyridoxine)
Patients with meningeal tuberculosis are treated for a prolonged period (at least 12 months) with the addition of steroids
Directly observed therapy with a three times a week dosing regimen may be
indicated in certain groups, including:
- homeless people with active tuberculosis
- patients who are likely to have poor concordance
- all prisoners with active or latent tuberculosis
Complications of treatment
Immune reconstitution disease
- occurs typically 3-6 weeks after starting treatment
- often presents with enlarging lymph nodes
Drug adverse effects
- rifampicin
- potent liver enzyme inducer
- hepatitis, orange secretions
- flu-like symptoms
- isoniazid
- peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
- hepatitis, agranulocytosis
- liver enzyme inhibitor
- pyrazinamide
- hyperuricaemia causing gout
- arthralgia, myalgia
- hepatitis
- ethambutol
- optic neuritis: check visual acuity before and during treatment
+PassMedicine Notes
The standard therapy for treating active tuberculosis is:
Initial phase - first 2 months (RIPE)- Rifampicin
- Isoniazid
- Pyrazinamide
- Ethambutol (the 2006 NICE guidelines now recommend giving a 'fourth drug' such as ethambutol routinely - previously this was only added if drug-resistant tuberculosis was suspected)
- Rifampicin
- Isoniazid
The treatment for latent tuberculosis is 3 months of isoniazid (with pyridoxine) and rifampicin OR 6 months of isoniazid (with pyridoxine)
Patients with meningeal tuberculosis are treated for a prolonged period (at least 12 months) with the addition of steroids
Directly observed therapy with a three times a week dosing regimen may be indicated in certain groups, including:- homeless people with active tuberculosis
- patients who are likely to have poor concordance
- all prisoners with active or latent tuberculosis
Complications of treatment
Immune reconstitution disease- occurs typically 3-6 weeks after starting treatment
- often presents with enlarging lymph nodes
- rifampicin
- potent liver enzyme inducer
- hepatitis, orange secretions
- flu-like symptoms
- isoniazid
- peripheral neuropathy: prevent with pyridoxine (Vitamin B6)
- hepatitis, agranulocytosis
- liver enzyme inhibitor
- pyrazinamide
- hyperuricaemia causing gout
- arthralgia, myalgia
- hepatitis
- ethambutol
- optic neuritis: check visual acuity before and during treatment
