علاج ال TB بطريقة مبسطة

🔹MUCOM Pediatric lec. 2023



Treatment for Tuberculosis (TB) 😷
🥇 First-line drugs:
1️⃣ Rifampicin
2️⃣ Isoniazid (INH)
3️⃣ Ethambutol
4️⃣ Streptomycin
5️⃣ Pyrazinamide

🥈 Second-line drugs:
1️⃣ Amikacin
2️⃣ Capreomycin
3️⃣ Ethionamide
4️⃣ Ciprofloxacin

💊 Steroids are used for specific types of TB:
1️⃣ TB meningitis (2 weeks) 🧠
2️⃣ TB pericarditis ❤️
3️⃣ TB peritonitis 🫂
4️⃣ Miliary TB 🦠


❗Noncompliance is a major issue in TB control due to the long-term nature of treatment and patients' social circumstances. Shorter treatment regimens require even greater adherence. Compliance improves with directly observed therapy (DOT), where a healthcare worker is present when medications are administered. 👩‍⚕️

🔍 Latent tuberculosis infection (positive TST result, no disease):
• 9️⃣ months of Isoniazid daily; if daily therapy is not possible, use DOT twice a week for 9 months
🔄 If Isoniazid-resistant, use Rifampicin for 6️⃣ months daily.
🫁 Pulmonary and Extrapulmonary TB (excluding meningitis and bone/joint TB):
• 2️⃣ months of Isoniazid, Rifampicin, and Pyrazinamide daily.
• Followed by 4️⃣ months of Isoniazid and Rifampicin twice weekly under DOT.
• If drug resistance is a concern, add another drug (Ethambutol or an Aminoglycoside) to the initial 3-drug therapy until drug susceptibilities are determined. 💊


🧠💀 Meningitis, TB of Bone/Joint:
• 2️⃣ months of Isoniazid, Rifampicin, Pyrazinamide, and either an Aminoglycoside or Ethionamide, once a day.
• Followed by 7️⃣-1️⃣0️⃣ months of Isoniazid and Rifampicin, once a day or twice a week (9️⃣-1️⃣2️⃣ months total).
⏳ Most infectious patients become noninfectious within 2️⃣ weeks of starting effective treatment, and many within several days.



🛡️ Prevention:
1️⃣ Improve living conditions, such as housing, nutrition, and addressing social deprivation. 🏠🍎
2️⃣ BCG vaccination. 💉
3️⃣ Chemoprophylaxis: If a child has contact with active TB, administer Isoniazid (INH) for 3️⃣ months, then perform a TST. If positive, continue INH for a further 6️⃣ months. If negative, discontinue INH. 👶🔬