Curable infectious disease on the rise - tuberculosis

- 20mil active cases worldwide

- 50 to 100 mil children

- mortality 3mil annually

- 80% in developing countries

- since 1989 Malaysia detected average 11 to 12 thousand cases annually

- diagnosis: clinical + radiological + / - bacteriological

The tuberculin or Mantoux test has some role in the diagnosis of tuberculosis especially in paediatric cases and cases of extra-pulmonary tuberculosis.

The Mantoux test is used in Malaysia using the strength of 10 IU PPD. The result is read after 72 hours.

THE AIMS OF TREATMENT ARE:

1. To cure patients and render them non-infectious

2. To reduce morbidity and mortality

3. To prevent relapse and emergence of resistant tubercle bacilli.

Basic investigations:-

1.Sputum D/S x 3,

2.sputum culture AFB if D/S negative,

3.renal profile,

4.liver functions,

5.visual test (if ethambutol is used ),

6.blood sugar,

7.HIV test when indicated.

Treatment:-

isoniazid (H) 100mg / tab

rifampicin (R) /cap

pyrazinamide (Z) 250mg or 500mg/tab

streptomycin (S) im

ethambutol (E) 400mg/tab

1. daily intensive phase (at least 2/12) SHRZ or EHRZ

INH 5mg/kg/day (max 300mg daily)

rifampicin 10mg/kg/day (max 600mg daily)

pyrazinamide 25mg/kg/day (max 2000mg daily)

+/-

streptomycin 15mg/kg/day (max 1000mg daily; omit in elderly)

ethambutol 15 to 25 mg/kg/day (max 1200mg daily)

2. biweekly phase (4/12) eg S2H2R2

INH ] max 1000mg biweekly

rifampicin ] 15mg/kg/ biweekly max 600mg biweekly

streptomycin ] max 1000mg biweekly

reference:-

1) CPG on Management if Tuberculosis. Ministry of Health Malaysia.