Tuberculosis - I.T. Piatnochka 2005

Treatment of Tuberculosis
Clinical Recovery

This is a stable healing of the tuberculosis process, confirmed by clinical, radiological, and laboratory Methods over differentiated follow-up periods. These periods are determined taking into account

2 main parameters: 1) the magnitude of residual changes (minor and major) and 2) the presence of aggravating factors (unfavorable living conditions, severe chronic comorbidities, steroid and Radiation therapy).

The Main criteria for clinical recovery are the absence of general and local signs of tuberculous intoxication, sustained cessation of mycobacterial excretion (absence of MBT for a year after the main course), absence of radiological signs of active tuberculosis, restoration of respiratory, circulatory, and other organ and system Functions, and recovery of working capacity (full or partial). In cases of minor residual changes, clinical recovery can be stated after 1 year, whereas in cases of major post-tuberculosis changes or minor Changes in the presence of aggravating factors, it can be stated after 2 years of follow-up following the successful completion of the Treatment course.

Review Questions

1. Classification of antimycobacterial drugs.

2. Characteristics of group I, II, and III antimycobacterial drugs.

3. Basic principles of treatment for patients with Pulmonary Tuberculosis.

4. Antimycobacterial therapy regimens recommended by the WHO for treating various categories of patients (newly diagnosed patients with MBT(+) and MBT(-), those with tuberculosis relapses, and chronic forms of pulmonary tuberculosis).

5. Main agents of Pathogenetic Therapy in patients with pulmonary tuberculosis.

6. Methods and remedies of traditional medicine in the complex treatment of patients with pulmonary tuberculosis.

7. Collapse therapy methods in the treatment of patients with pulmonary tuberculosis.

8. Surgical treatment and its indications in patients with pulmonary tuberculosis.

9. Criteria for clinical recovery in patients with pulmonary tuberculosis.

TESTS

1. The WHO recommends appropriate treatment regimens for tuberculosis patients depending on their category. How many such categories are there?

A. 1

B. 2

C. 3

D. 4

E. 5

2. Which of the listed antimycobacterial drugs are the most effective?

A. Streptomycin and pyrazinamide

B. Isoniazid and rifampicin

C. Ethambutol and kanamycin

D. Ethionamide and cycloserine

E. Thioacetazone and PAS

3. Optimal duration of the main course of antimycobacterial therapy for a patient with newly diagnosed pulmonary tuberculosis (13.08.2003) of the upper lobe of the left lung (focal) (infiltration), Dest-, MBT-M-K-, Hist0, Cat3 Cog3(2003).

A. 1-2 months

B. 3-4 months

C. 4-6 months

D. 7-8 months

E. 9-10 months

4. A patient is diagnosed with miliary pulmonary tuberculosis, MBT (+). What is the duration of the main course of antimycobacterial therapy for this patient?

A. 2-3 months

B. 4-5 months

C. 6-7 months

D. 8-12 months

E. More than 1.5 years

5. A patient has newly diagnosed pulmonary tuberculosis (05.09.2004) of the upper lobe of the right lung (Tuberculoma), Dest-, MBT-M-K-, Hist0. Choose the optimal antimycobacterial therapy regimen for the intensive phase.

A. Isoniazid + rifampicin + streptomycin

B. Isoniazid + rifampicin + pyrazinamide

C. Isoniazid + streptomycin + pyrazinamide

D. Rifampicin + streptomycin + ethambutol

E. Pyrazinamide + kanamycin + ethambutol

6. Which of the antimycobacterial drugs is characterized by ototoxic effects, making it contraindicated in pregnant women?

A. Ethambutol

B. Rifampicin

C. Streptomycin

D. Pyrazinamide

E. Isoniazid

7. Which of the following combinations of antimycobacterial drugs is rational?

A. Streptomycin + kanamycin + viomycin

B. Kanamycin + viomycin + isoniazid

C. Rifampicin + pyrazinamide + isoniazid

D. Isoniazid + phthivazide + PASA

E. Ethambutol + PASA + thioacetazone

8. To prevent the neurotoxic effects of isoniazid, the following is prescribed:

A. Vitamin C

B. vitamin A

C. vitamin B₆

D. vitamin B₁₂

E. diazolin

9. In which form and complication of pulmonary tuberculosis is it most advisable to prescribe prednisolone?

A. Infiltrative pulmonary tuberculosis complicated by exudative Pleurisy

B. Chronic disseminated pulmonary tuberculosis, Chronic Cor Pulmonale

C. Fibrocavernous pulmonary tuberculosis, internal organ amyloidosis

D. Tuberculoma of the upper lobe of the right lung, specific colitis

E. Cirrhotic pulmonary tuberculosis, pulmonary aspergilloma

10. Duration of antimycobacterial therapy following a successful resection of the upper lobe of the right lung for tuberculoma.

A. 1-2 weeks

B. 3-4 weeks

C. 2-3 months

D. 4-6 months

E. 7-10 months

11. Patient R., 48 years old, newly diagnosed pulmonary tuberculosis (17.07.2003) of the upper lobe of the left lung (infiltrative) (dissemination), Dest+, MBT+M-K+, Resist-, Hist0, Cat1 Cog3(2003). Non-compliant. Antimycobacterial drugs (isoniazid, rifampicin, streptomycin, pyrazinamide) were taken irregularly, with interruptions. At home, the patient developed general weakness, fever, lower back and leg pain, and nausea. Upon examination, sclera and mucous membranes are icteric, the Liver is enlarged and tender. Urine has a reddish tint due to Blood hemolysis. The most probable cause of this condition is.

A. Tuberculosis progression

B. Viral Hepatitis

C. Adverse reaction to pyrazinamide

D. Immunological reaction caused by rifampicin

E. Toxic-allergic reaction to isoniazid

12. A patient being treated for pulmonary tuberculosis with isoniazid, rifampicin, pyrazinamide, ethambutol, and ofloxacin experienced a decrease in visual acuity and color perception. Which of the drugs could be the cause of this complication?

A. Ofloxacin

B. Pyrazinamide

C. Ethambutol

D. Rifampicin

E. Isoniazid

13. In which dispensary follow-up group is anti-relapse Chemotherapy performed?

A. 5.1

B. 5.2

C. 5.3

D. 5.4

E. 5.5

PROBLEMS

1. In the third week of treatment with isoniazid, rifampicin, streptomycin, and ethambutol, a female patient diagnosed with newly diagnosed pulmonary tuberculosis (NDPTB) (22.12.2003) of the upper lobe of the right lung (infiltrative), Dest+, MBT+M-K+, Resist-, HistO, Cat1 Cog4(2003) developed a sensation of intoxication (drunkenness), tinnitus, and Hearing loss.

a) What caused these symptoms?

b) Your tactical management.

Answer: a) streptomycin; b) replace streptomycin with pyrazinamide; administer glucose, Vitamins B₁, B₆, glutamic acid, and short-term Diuretics.

2. Prescribe a combination of antimycobacterial drugs for a patient with relapsed pulmonary tuberculosis (13.08.2003) (disseminated) (infiltration), Dest+, MBT+M+K+, Resist+(H, R), Hist0, respiratory failure II st., chronic cor pulmonale, Heart Failure IIA st., Cat2 Cog3(2003). Justify this prescription.

3. Prescribe a combination of antimycobacterial drugs for a 25 kg child with newly diagnosed pulmonary tuberculosis (02.04.2004) of the right lung (Primary tuberculosis complex), Dest+, MBT+M-K+, Resist-, Hist0, Cat1 Cog2(2004).

4. Patient Z., aged 21, newly diagnosed pulmonary tuberculosis (21.05.2004) of the upper lobe of the left lung (focal) (infiltration), Dest+, MBT+M-K+, Resist-, Hist0, Cat1 Cog2 (2004).

a) Outline a plan for antimycobacterial therapy.

b) Prescribe pathogenetic treatment.

5. Patient V., aged 45, presents with newly diagnosed pulmonary tuberculosis (07.09.2003) of the right lung (Caseous Pneumonia), Dest+, MBT+M+K+, Resist+(S,H), Hist0, respiratory failure grade II, Cat 1 Cohort 3 (2003).

a) Outline a plan for antimycobacterial therapy.

b) Prescribe non-specific pharmacotherapy.

6. Patient K., aged 35, was admitted to the tuberculosis dispensary 3 months ago for chronic pulmonary tuberculosis (25.11.2003) of the upper lobe of the right lung (infiltrative), Dest+, MBT+M+K+, Resist+ (H), Hist0, respiratory failure grades I–II, chronic cor pulmonale, heart failure stage IIA, Cat 4 Cohort 4 (2003). During the course of treatment, the patient's general condition significantly improved, infiltrative changes in the Lungs resolved, and bacterial excretion ceased, but a cavity measuring 3 cm in diameter persists.

What is the further treatment strategy?