Treatment of Special TB cases

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Pregnant Women

Most anti-TB drugs are safe for use in pregnant women with the exception of aminoglycosides which is ototoxic (deafness, vertigo) to the foetus.  All pregnant women should be treated using DOTS.

Breastfeeding Women

Patients should receive the full course of anti-TB chemotherapy as the drugs do not cause any harm to the baby.  Regardless of prior vaccination with BCG, the infant should be given chemoprophylaxis for a minimum period of six months and then vaccinated with BCG if not vaccinated before.

Treatment of people living with HIV (PLHIVs) co-infected with TB

Patients infected with HIV respond equally well to TB treatment as those without HIV infection Strat TB treatment first and commence ARVS within 2-8 weeks (convert to smear negative).  See guidelines in HIV sections

Treatment of patients with both TB and Leprosy

  • Required appropriate anti-TB treatment in addition to the standard MDT
  • Rifampicin should be given in doses required for TB
  • Patient should continue with anti-leprosy treatment once TB treatment is complete.

Summarizes the treatment of TB in special cases

Type of EPTB

TB treatment regimen

Comments

TB Meningitis (adult)

2HRZE/7-10HR

Add 2-4mg/kg/day prednisone, taper over 6-8 weeks

9-12 months total treatment

TB Meningitis (children)

2HRZE/10HR

Add 2-4mg/kg/day prednisone, taper over 6-8 weeks

12 months total treatment

Osteoarticular TB (adult)

2HRZE/7HR

9 months total treatment

Osteoarticular TB (children)

2HRZE/10HR

12 months total treatment

Pericardial TB

2HRZE/4HR

Add 2-4mg/kg/day prednisone, taper over 6-8 weeks

6 months total treatment

Prevention of tuberculosis

  • Standard precautions: cough etiquette, isolation, use of personal protective equipment like face mask.
  • See the National Infection Prevention and Control Guideline for the hierarchy of TB prevention
  • Chemoprophylaxis of TB: recommended for HIV patients without active TB. Isoniazid 300mg oral daily for adults or 10mg/kg body weight daily for 6 months. Contraindicated in patients with active hepatitis
  • Immunization: BCG vaccine at 0 week under the Expanded Programme on Immunization

Referral 

  • All patients with rifampicin resistance should be referred to Lakka or Regional Government Hospital. Please inform the TB district supervisor.