Treatment of Active TB | Infectious diseases | NCLEX-RN | Khan Academy

Summary

This video covers the treatment of active tuberculosis (TB) infection, focusing on the importance of preventing disability, death, and the spread of the disease. It highlights the use of four main drugs (rifampin, isoniazid, pyrazinamide, ethambutol) for an initial two-month intensive phase, followed by a four-month consolidation phase. The video stresses patient compliance through directly observed therapy (DOT), the challenges of long treatment durations, and the need to monitor side effects such as hepatitis and neuropathy. It also discusses special cases requiring extended treatment, including TB in pregnant women, HIV co-infections, and severe forms of TB.

Takeaways

• 💊 Tuberculosis (TB) treatment aims to prevent disability and death, and also reduce the spread of infection to others.
• 🔬 Treatment of active TB begins with a combination of four drugs (Rifampin, Isoniazid, Pyrazinamide, and Ethambutol), acronym RIPE, administered for the first two months.
• 🧫 These four drugs work to quickly kill TB bacteria during the intensive phase of treatment.
• 📅 After the initial two months, treatment typically continues with Rifampin and Isoniazid for an additional four months, totaling six months of therapy.
• 🔎 Treatment duration can be extended for severe cases such as TB meningitis, bone infections, or if the patient is co-infected with HIV or pregnant.
• 👀 Directly Observed Therapy (DOT) ensures patients take their medication correctly, helping improve cure rates and reduce drug resistance.
• 📉 Monitoring the patient regularly for treatment progress, drug compliance, and side effects is essential to successful TB treatment.
• 🛑 Rifampin can cause hepatitis, drug interactions, and discoloration of bodily fluids, while Isoniazid may lead to hepatitis or peripheral neuropathy.
• 🧪 Pyrazinamide can raise uric acid levels and cause gout, while Ethambutol may result in optic neuritis affecting vision.
• 🩺 Monthly monitoring with clinical evaluations and sputum cultures is crucial to ensure the infection is being effectively controlled and to adjust treatment as needed.

Q & A

What is the primary goal of treating active tuberculosis (TB)?

The primary goal is to prevent disability and death from the infection and to reduce the spread of TB to other individuals.

Why is the treatment of active TB more complex than other infectious diseases?

The treatment is more complex because it requires a long duration, often involves multiple drugs, and there is a growing issue of resistance among TB strains.

What does the acronym RIPE stand for in the context of TB treatment?

RIPE stands for Rifampin, Isoniazid (INH), Pyrazinamide (PZA), and Ethambutol. These are the four drugs typically used in the initial phase of TB treatment.

How long does the intensive phase of TB treatment typically last, and why is this phase important?

The intensive phase typically lasts two months and involves all four RIPE drugs. This phase is important for killing the majority of the TB bacteria quickly.

What is the purpose of the consolidation phase in TB treatment, and which drugs are used?

The consolidation phase lasts for four months, during which only Rifampin and INH are used. This phase aims to eliminate any remaining TB bacteria after the intensive phase.

What factors could extend the duration of TB treatment beyond the typical six months?

Factors that may require longer treatment include more severe forms of TB (like TB meningitis or TB of the bones), HIV co-infection, pregnancy, persistent positive cultures, and resistant TB strains.

What is directly observed therapy (DOT), and why is it important in TB treatment?

Directly observed therapy (DOT) is when a healthcare provider ensures that the patient is taking their medications. It is important because it helps increase cure rates and reduce the risk of drug resistance.

What are some strategies to improve patient compliance with TB treatment?

Strategies include offering three-times-a-week therapy under DOT, using combination medications, providing incentives like meals or travel vouchers, and making clinic visits convenient.

What are some common side effects of Rifampin in TB treatment?

Rifampin can cause hepatitis, decreased platelet counts (thrombocytopenia), and drug interactions. It may also turn secretions like urine and tears red, which is more of an annoyance.

What are the side effects of Isoniazid (INH) and how can they be managed?

INH can cause hepatitis and peripheral neuropathy, especially in patients with poor nutrition or chronic conditions. The neuropathy can be managed by prescribing pyridoxine (vitamin B6) alongside INH.