Tuberculosis : Interprofessional care

Interprofessional care

  • Hospitalization not necessary for most patients
  • Infectious for first 2 weeks after starting treatment if sputum +
  • Drug therapy used to prevent or treat active disease
  • Need to monitor compliance

Drug therapy

  • Active disease
    • Treatment is aggressive 
    • Two phases of treatment
      • Initial (8 weeks)
      • Continuation (18 weeks)
    • Four-drug regimen
      • Isoniazid
      • Rifampin (Rifadin)
      • Pyrazinamide
      • Ethambutol
    • Patients should be taught about side effects and when to seek medical attention
    • Liver function should be monitored
    • Alternatives are available for those who develop a toxic reaction to primary drugs
  • Directly observed therapy (DOT)
    • Noncompliance is major factor in multidrug resistance and treatment failures
    • Requires watching patient swallow drugs
    • Preferred  strategy to ensure adherence
    • May be administered by public health nurses at clinic site
  • Latent TB infection
    • Usually treated with Isoniazid for 6 to 9 months
    • HIV patients should take Isoniazid for 9 months
    • Alternative  3-month regimen of Isoniazid and rifapentine OR 4 months of rifampin
  • Vaccine
    • Bacille-Calmette-Guérin (BCG) vaccine to prevent TB is currently in use in many parts of world
    • In United States, not recommended except for very select individuals
    • Can result in positive PPD reaction

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