Stop TB TEROBOSAN MENUJU AKSES UNIVERSAL STRATEGI NASIONAL PENGENDALIAN TB DI INDONESIA 2010-2014 ISBN: 978-602-8937-43-7 Kementerian Kesehatan rePUBLiK inDOnesia. Konsultan analisis data statistik untuk penelitian mahasiswa, lembaga, dan umum.
Tuberculosis management - Wikipedia. Various pharmaceutical tuberculosis treatments and their actions. Tuberculosis management refers to the medical treatment of the infectious diseasetuberculosis (TB). The standard . The patient is considered to be free of living bacteria after six months (although there is still a relapse rate of up to 7%). For latent tuberculosis, the standard treatment is six to nine months of daily isoniazid alone or three months of weekly (1. Ethambutol need not be used. First line. In the US only, streptomycin is no longer considered a first line drug by ATS/IDSA/CDC because of high rates of resistance.
The drugs are listed using their single letter abbreviations (in the order given above, which is roughly the order of introduction into clinical practice). A prefix denotes the number of months the treatment should be given for; a subscript denotes intermittent dosing (so 3 means three times a week) and no subscript means daily dosing.
Most regimens have an initial high- intensity phase, followed by a continuation phase (also called a consolidation phase or eradication phase): the high- intensity phase is given first, then the continuation phase, the two phases divided by a slash. So,2. HREZ/4. HR3means isoniazid, rifampicin, ethambutol, pyrazinamide daily for two months, followed by four months of isoniazid and rifampicin given three times a week. These standard abbreviations are used in the rest of this article. Second line. Rifabutin is effective, but is not included on the WHO list because for most developing countries, it is impractically expensive. The standard regimen.
Doodle jump pour vivaz gratuit Aliena from tankspot owned 06-7730-8360 fax Hector lavoe quotes Super kush botanical potpourri side effects Hot stuff seamless female. Ask.com is the #1 question answering service that delivers the best answers from the web and real people - all in one place. Pengembangan pengobatan TB paru yang efektif merupakan hal yang penting untuk menyembuhkan pasien dan menghindari MDR TB (multidrug resistant tuberculosis).
Drugs are not used singly (except in latent TB or chemoprophylaxis), and regimens that use only single drugs result in the rapid development of resistance and treatment failure. The rate of spontaneous mutations that confer resistance to an individual drug are well known: 1 mutation for every 1. EMB, 1 for every 1. STM and INH, and 1 for every 1. RMP. Resistance mutations appear spontaneously and independently, so the chances of them harbouring a bacterium that is spontaneously resistant to both INH and RMP is 1 in 1. This is, of course, an oversimplification, but it is a useful way of explaining combination therapy. There are other theoretical reasons for supporting combination therapy.
The different drugs in the regimen have different modes of action. INH are bacteriocidal against replicating bacteria. EMB is bacteriostatic at low doses, but is used in TB treatment at higher, bactericidal doses. RMP is bacteriocidal and has a sterilizing effect. PZA is only weakly bactericidal, but is very effective against bacteria located in acidic environments, inside macrophages, or in areas of acute inflammation. All TB regimens in use were 1.
Kegemukan atau obesitas adalah suatu kondisi medis berupa kelebihan lemak tubuh yang terakumulasi sedemikian rupa sehingga menimbulkan dampak merugikan bagi kesehatan. Mitra Riset Konsultan Analisis Data Statistik Berpengalaman Sejak Tahun 2002 Membantu Penelitian Mahasiswa S1, S2, S3 dan Dosen serta Lembaga Pemerintah dan Swasta.
In 1. 95. 3, the standard UK regimen was 3. SPH/1. 5PH or 3. SPH/1. SH2. Between 1. 96.
EMB replaced PAS. RMP began to be used to treat TB in 1. BTS study in the 1. HRE/7. HR was efficacious. In 1. 98. 4, a BTS study showed that 2. HRZ/4. HR was efficacious.
The WHO also recommend a six- month continuation phase of HR if the patient is still culture positive after 2 months of treatment (approximately 1. TB) and for those patients who have extensive bilateral cavitation at the start of treatment. Monitoring, DOTS, and DOTS- Plus.
The DOTS strategy focuses on five main points of action. These include government commitment to control TB, diagnosis based on sputum- smear microscopy tests done on patients who actively report TB symptoms, direct observation short- course chemotherapy treatments, a definite supply of drugs, and standardized reporting and recording of cases and treatment outcomes. The independent observer is often not a healthcare worker and may be a shopkeeper or a tribal elder or similar senior person within that society.
DOTS is used with intermittent dosing (thrice weekly or 2. HREZ/4. HR3). Twice weekly dosing is effective. Administering DOTS, decreases the possibilities of tuberculosis from recurring, resulting in a reduction in unsuccessful treatments. This is in part due to the fact that areas without the DOTS strategy generally provide lower standards of care.
In order for the program to work efficiently and accurately health providers must be fully engaged. DOTS- Plus is therefore much more resource- expensive than DOTS, and requires much greater commitment from countries wishing to implement it. Resource limitations mean that the implementation of DOTS- Plus may lead inadvertently to the diversion of resources from existing DOTS programmes and a consequent decrease in the overall standard of care. If cultures are positive or symptoms do not resolve after three months of treatment, it is necessary to re- evaluate the patient for drug- resistant disease or nonadherence to drug regimen. If cultures do not convert to negative despite three months of therapy, some physicians may consider admitting the patient to hospital so as to closely monitor therapy.
Tuberculosis not affecting the lungs is called extra- pulmonary tuberculosis. Disease of the central nervous system is specifically excluded from this classification. The UK and WHO recommendation is 2. HREZ/4. HR; the US recommendation is 2. HREZ/7. HR. There is good evidence from randomised- controlled trials to say that in tuberculous lymphadenitis. This should not be interpreted as failure of therapy and is a common reason for patients (and their physicians) to panic unnecessarily.
With patience, two to three months into treatment the lymph nodes start to shrink again and re- aspiration or re- biopsy of the lymph nodes is unnecessary: if repeat microbiological studies are ordered, they will show the continued presence of viable bacteria with the same sensitivity pattern, which further adds to the confusion: physicians inexperienced in the treatment of TB will then often add second- line drugs in the belief that the treatment is not working. In these situations, all that is required is re- assurance. Steroids may be useful in resolving the swelling, especially if it is painful, but they are unnecessary. Additional antibiotics are unnecessary and the treatment regimen does not need to be lengthened. PCR of CSF does not significantly improve the microbiology yield; culture remains the most sensitive method and a minimum of 5 ml (preferably 2. CSF should be sent for analysis. TB cerebritis (or TB of the brain) may require brain biopsy in order to make the diagnosis, because the CSF is commonly normal: this is not always available and even when it is, some clinicians would debate whether it is justified putting a patient through such an invasive and potentially dangerous procedure when a trial of anti- TB therapy may yield the same answer; probably the only justification for brain biopsy is when drug- resistant TB is suspected.
It is possible that shorter durations of therapy (e. TB meningitis, but no clinical trial has addressed this issue. The CSF of patients with treated TB meningitis is commonly abnormal even at 1.
TB meningitis usually responds well to treatment, but TB cerebritis may require prolonged treatment (up to two years) and the steroid course needed is often also prolonged (up to six months). Unlike TB meningitis, TB cerebritis often required repeated CT or MRI imaging of the brain to monitor progress. Central nervous system TB may be secondary to blood- borne spread: therefore some experts advocate the routine sampling of CSF in patients with miliary TB. There is evidence from one poorly designed trial that aspirin may be beneficial. The dose for TB meningitis is dexamethasone 8 to 1.
Thwaites et al., 2. The dose for pericarditis is prednisolone 6. Steroids may be of temporary benefit in pleurisy, extremely advanced TB, and TB in children: Pleurisy: prednisolone 2.
Extremely advanced TB: 4. TB in children: 2 to 5 mg/kg/day for one week, 1 mg/kg/day the next week, then tapered off over 5 weeks. Steroids may be of benefit in peritonitis, miliary disease, tubercular osteomyelitis, TB osteomyelitis, laryngeal TB, lymphadenitis and genitourinary disease, but the evidence is scant and the routine use of steroids cannot be recommended.
Steroid treatment in these patients should be considered on a case by case basis by the attending physician. The symptoms of TB commonly resolve within a few weeks of starting TB treatment and many patients then lose motivation to continue taking their medication. Regular follow- up is important to check on compliance and to identify any problems patients are having with their medication. Patients need to be told of the importance of taking their tablets regularly, and the importance of completing treatment, because of the risk of relapse or drug- resistance developing otherwise.
One of the main complaints is the bulkiness of the tablets. The main offender is PZA (the tablets being the size of horse tablets). PZA syrup may be offered as a substitute, or if the size of the tablets is truly an issue and liquid preparations are not available, then PZA can be omitted altogether. If PZA is omitted, the patient should be warned that this results in a significant increase in the duration of treatment (details of regimens omitting PZA are given below). The other complaint is that the medicines must be taken on an empty stomach to facilitate absorption.
This can be difficult for patients to follow (for example, shift workers who take their meals at irregular times) and may mean the patient waking up an hour earlier than usual everyday just to take medication. The rules are actually less stringent than many physicians and pharmacists realise: the issue is that the absorption of RMP is reduced if taken with fat, but is unaffected by carbohydrate, protein. The effect of food on the absorption of INH is not clear: two studies have shown reduced absorption with food.