内科学肺结核(英文).ppt

How to judge the activity of pulmonary tuberculosis How to write the diagnosis correctly? Generally, we write the diagnosis according to the site of TB, clinical patterns, the result of sputum examination and the history of chemotherapy. Upper Right secondary pulmonary tuberculosis, smear(-), retreatment Differential Diagnosis Differential Diagnosis :lung cancer complications Pneumothorax Bronchiectasis Empyema Extrapulmonary expansion Hemoptysis Chronic pulmonary heart disease Therapy The principles of antituberculous chemotherapy Treatment The critical issue in TB control is adopting the DOTS (1995) ( Directly Observed Treatment, Short-course therapy); DOTS Strategy is recommended by the WHO TB Program. Isoniazid (INH)  Isoniazid is a principal agent used to treat tuberculosis It is universally accepted for initial treatment Now considered the best antituberculous drug It should be included in all TB treatment regimens unless the organism is resistant Advantages and Dosage Inexpensive Highly selective for mycobacteria Well tolerated(about only 5% of patients exhibiting adverse effects) 4-8 mg/kg daily for both groups a 300mg daily oral dose is adopted Adverse effects The two most important adverse effects of isoniazid therapy : hepatotoxicity peripheral neuropathy Rifampin (RFP)  It is also considered the most important and potent antituberculosis agent Like isoniazid it is bactericidal and highly effective It has both intracellular and extracellular anti-bacterial activity Dosage 450-600mg daily or twice weekly Adverse effects gastrointestinal upset hepatitis Pyrazinamide (PZA) Pyrazinamide is a major oral agent used against mycobacteria It is an important bactericidal drug used in short-course therapy for tuberculosis The drug is used to kill intracellular tubercle bacillus It