Guidelines for chemotherapy of tuberculosis in Taiwan.pptVIP

Guidelines for chemotherapy of tuberculosis in Taiwan 馬偕紀念醫院 一般內科及感染科 主治醫師 曾祥洸 2005-3-9 Infectious Disease Society of TaiwanThe Society of Tuberculosis, TaiwanMedical Foundation in Memory of Dr. Deh-Lin Cheng (J Microbiol Immunol Infect 2004;37:282-384) Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and EducationCY Lee’s Research Foundation for Pediatric Infectious Diseases and Vaccines Three principles for the guidelines 1. From the viewpoint of primary care physician 2. Antimicrobial agents recommended already marketed in Taiwan 3. Base on academic principles rather than the regulation of the Bureau of National Health Insurance Guidelines for chemotherapy of tuberculosis in Taiwan(J Microbiol Immunol Infect 2004;37:282-384) New Case Pulmonary tuberculosis Drugs of choice for New case 1. Standard regimen: (total 6 months) INH+RIF+EMB+PZA for 2 months, Then INH+RIF+EMB for 4 months 2. Fixed-dose combinations: (total 6 months) Rifater+EMB for 2 months Then Rifinah+EMB for 4 months cavitations on initial chest X ray and/or positive cultures at completion of initial 2 months’ treatment, ? extend treatment to total 9 months. Guidelines for chemotherapy of tuberculosis in Taiwan(J Microbiol Immunol Infect 2004;37:282-384) Retreatment Pulmonary tuberculosis Drugs of choice for Retreatment (total 8 months) 1. Relapse 2. Default 3. Failure INH+RIF+EMB+PZA+IA for 3 months, Then INH+RIF+EMB for 5 months IA: Injectable aminoglycosides include streptomycin, kanamycin, and amikacin, and should be administered in the initial 2 months of treatment Retreatment 1. Relapse is defined as a patient who develops active tuberculosis (by culture, clinical or radiological deterioration) after completion of anti-tuberculous therapy. 2. Default is defined as interruptions in therapy of longer than 2 months. 3. Failure is defined as continued or recurrent positive cultures after 4 months of treatment in patients with as