Tuberculosis Study Guide - M.M. Savula 2002

Prevention
Chemoprophylaxis

Chemoprophylaxis is the preventive use of antituberculosis drugs in groups at high risk of developing tuberculosis.

A distinction is made between primary chemoprophylaxis (administered to uninfected individuals to prevent tuberculosis infection and disease) and secondary chemoprophylaxis (aimed at preventing The Development of active disease in previously infected individuals). Isoniazid is typically prescribed at a daily dose of 8-10 mg/kg, up to a maximum of 0.45 g for children and 0.6 g for adolescents per day. Treatment is administered daily at a dose of 8 mg/kg or every other day at 10 mg/kg. Isoniazid can be replaced with phthivazide at 30 mg/kg per day. The daily dose of isoniazid is administered as a single dose 15-20 minutes after dinner. Vitamin preparations containing vitamin B₆ (such as Revit, Pentovit, Aerovit, etc.) are prescribed concurrently with isoniazid or phthivazide.

Indications for tuberculosis chemoprophylaxis in children and adolescents:

1. Household or close contact with an infectious patient, and household contact with a patient with active Pulmonary Tuberculosis without bacterial shedding.

2. Tuberculin Skin test conversion (primary infection).

3. Hyperergic reactions to tuberculin (an induration of 17 mm or more in the Mantoux test with 2 TU, or The formation of a vesicle or lymphangitis with a papule size of less than 17 mm).

The duration of chemoprophylaxis is 3 months. Courses may be repeated as prescribed by a phthisiologist.

In adults, chemoprophylaxis or anti-relapse treatment is carried out on an outpatient basis under the supervision of a paramedic or other healthcare worker for the following indications:

1. Individuals in contact with infectious tuberculosis patients.

2. Individuals cured of tuberculosis (dispensary registration group III) in the event of factors that reduce body resistance (severe illnesses, trauma, treatment with corticosteroids or other immunosuppressants).

3. People with residual post-tuberculosis changes (registration group VII) during exacerbations of chronic comorbid conditions or the occurrence of factors that reduce body resistance.

Chemoprophylaxis (drug, dose, duration) is prescribed by a phthisiologist after a thorough examination of the patient. For children, it is most practical to administer preventive treatment in children's sanatoriums. For individuals receiving chemoprophylaxis at their place of residence (or study), isoniazid is obtained by a paramedic from a tuberculosis dispensary. The paramedic dispenses a 7-day supply of the drug—to parents in the case of a child, or to the nurse of the children's facility or school under whose supervision the children take the isoniazid.

For individuals receiving chemoprophylaxis, the paramedic or the nurse of the children's facility starts a treatment sheet to record information about the administration of the antituberculosis drug. Upon completion of chemoprophylaxis, this sheet is pasted into the outpatient medical record. If side effects of isoniazid are suspected during chemoprophylaxis (numbness of the fingers, decreased skin sensitivity, a "pins and needles" sensation, allergic skin rashes, jaundice, or chest pain in The Heart area), the preventive treatment is suspended, and the child is referred to a phthisiologist for consultation.

Chemoprophylaxis reduces the risk of developing tuberculosis by half among those who receive it.

Questions

1. What do you understand by the term "chemoprophylaxis"?

2. Which drug is most commonly used for tuberculosis chemoprophylaxis?

3. What are the indications for chemoprophylaxis in children?

4. What is The Role of the paramedic in administering chemoprophylaxis?

5. What is the paramedic's course of action if side effects of isoniazid are suspected, and how might they manifest?