Tuberculosis seriously affects people’s health and is one of the key diseases in China. Timely and accurate diagnosis and complete cure of tuberculosis is not only to restore the health of patients, but also the most important measure to eliminate the source of infection and control the epidemic of tuberculosis. With the advancement of bacteriology, imaging, immunology and other diagnostic techniques, the widespread use of short-course chemotherapy and the increase in the number of elderly patients, drug-resistant patients, patients with combined diabetes and immune deficiency, the diagnosis and treatment of tuberculosis are becoming increasingly complex, and it is necessary to establish standardized diagnostic procedures and treatment guidelines so that tuberculosis specialists and other relevant medical and health institutions can reach a consensus and correctly master It is necessary to establish standardized diagnostic procedures and treatment guidelines in order to reach a consensus among tuberculosis physicians and other relevant medical and health institutions, to master the correct diagnostic techniques, to use rational chemotherapy regimens, and to improve the diagnosis and management of tuberculosis.
I. Clinical manifestations of pulmonary tuberculosis
The following manifestations should be considered as possible pulmonary tuberculosis, and further sputum and chest X-ray examination should be done. It should be noted that about 20% of patients with active tuberculosis may also be asymptomatic or have only mild symptoms.
1. Cough and sputum for three weeks or more, which may be accompanied by hemoptysis, chest pain, dyspnea, etc.
2, fever (often low fever in the afternoon), may be accompanied by night sweats, fatigue, reduced appetite, weight loss, menstrual disorders.
Allergic manifestations caused by tuberculosis allergic reaction: erythema nodosum, vesicular conjunctivitis and tuberculosis rheumatism (Poncet’s disease), etc.
4, tuberculin (PPD C5TU) skin test: China is a highly endemic country for tuberculosis, children are commonly vaccinated with BCG, a positive test is not significant for the diagnosis of tuberculosis, but for children who have not been vaccinated with BCG, it indicates that they are infected with Mycobacterium tuberculosis or have active tuberculosis in their bodies. When the test is strongly positive, it indicates that the body is in a hypersensitive state and has a high chance of developing tuberculosis, which can be used as a reference indication for clinical diagnosis of tuberculosis.
5, when suffering from tuberculosis, the lung signs are often not obvious. When the lung lesion is more extensive, the corresponding signs can be found, and small and medium-sized blister sounds can be heard when there is obvious cavitation or complication of bronchodilation. The narrowing of the Cornish isthmus suggests a lesion in the lung apex.
Imaging diagnosis of pulmonary tuberculosis
Bacteriological examination is the definitive basis for the diagnosis of pulmonary tuberculosis, but not all pulmonary tuberculosis can be bacteriologically confirmed. Chest X-ray is also often important. However, there are no characteristic changes in the chest X-ray of tuberculosis, and it is important to differentiate it from other lung diseases.
Generally speaking, the chest X-ray of tuberculosis may have the following characteristics:
1, mostly occurring in the posterior segment of the upper lobe, the dorsal segment of the lower lobe, and the posterior basal segment.
The lesions can be limited or invaded by multiple lung segments.
3, X-ray images may be polymorphic (i.e., exudative, proliferative, fibrous and caseous lesions), and may also be accompanied by calcification.
4. Easily combined with cavitation.
5.It may be accompanied by bronchial dissemination foci.
6.It may be accompanied by pleural effusion, pleural thickening and adhesions.
7.Spherical lesions (tuberculosis spheres) are mostly within 3 cm in diameter, surrounded by satellite lesions, and may have draining bronchial signs at the medial end.
8.Low absorption of lesions (less change within one month).
CT scan of the chest has complementary diagnostic value for the following cases:
1.Discovery of hidden lesions in the chest, including lesions in the trachea and bronchi.
2.Early detection of intra-pulmonary cornu shadows.
3.Differential diagnosis of mass shadows, cavities, isolated nodules and infiltrative shadows that are difficult to diagnose.
4.To understand the enlargement of the hilar and mediastinal lymph nodes, and to distinguish mediastinal lymph node tuberculosis from tumor.
5.Detection of small amount of pleural effusion, encapsulated effusion, interlobular effusion and other pleural lesions.
6.Differentiation of cysts from solid masses.
Pathogenetic diagnosis of pulmonary tuberculosis
1.Specimen collection and detection of tuberculosis bacilli: sources of specimens: sputum, ultrasonic nebulized sputum, lower respiratory tract sampling, bronchial washings, bronchoalveolar lavage fluid (BALF), lung and bronchial biopsy specimens. The quality of sputum specimens and whether to stop anti-tuberculosis drugs directly affect the positive results of TB bacilli detection and culture isolation rate. The positive rate of morning sputum smear is relatively high, and when the patient has little sputum, hypertonic saline ultrasonic nebulization can be used to induce sputum.
The smear examination was performed by using Cello-Ni antacid staining and fluorescent staining. The positive rate of the collection method is higher than that of the direct smear method. Positive smear staining can only indicate the presence of acid-resistant bacilli, but cannot distinguish between Mycobacterium tuberculosis and non-tuberculous branching bacilli. Since the incidence of non-tuberculous mycobacteriosis is relatively low in China, the detection of acid-fast bacilli is of great importance for the diagnosis of tuberculosis.
The direct smear method is simple and rapid, but the sensitivity is not high and should be used as a routine test. A negative smear cannot exclude tuberculosis, and its detection rate can be improved with ≥3 consecutive examinations.
Separate culture method is more sensitive than smear microscopy method, can directly obtain colonies, easy to distinguish from non-tuberculous branching bacilli, is the gold standard for the diagnosis of tuberculosis. The isolation rate can be higher in patients with tuberculosis who are not on anti-tuberculosis treatment or who have stopped taking the drug for 48-72 hours. Isolation culture method using modified Roche and BACTEC method, BACTEC method than the conventional modified Roche culture method to improve the primary isolation rate of about 10%, but also to identify non-tuberculous mycobacteria, the detection time is also significantly shortened.
2, tuberculosis drug susceptibility testing: tuberculosis sputum negative after the return of positive, chemotherapy for 3-6 months sputum bacteria still continue to be positive, sputum bacteria after treatment and continued increase and retreatment patients should be drug susceptibility testing. In areas with high rates of primary drug resistance, drug susceptibility testing is also feasible for primary TB treatment when available. At present, the indirect method of absolute concentration is used in China, and the proportional method can also be used, and the commonly used anti-tuberculosis drug resistance limits are shown in Table 1.
Table 1 Absolute concentration method commonly used anti-tuberculosis drug resistance limit
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
Concentration of drug contained in the medium (μg/ml)
Drug DDDDDDDDDDDDDDD Resistance limit (μg/ml)
High concentration Low concentration
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
Isoniazid (INH,H) 10 1 1
Streptomycin(SM,S) 100 10 10
Sodium p-aminosalicylate (PAS,P) 10 1 1
Ethambutol (EMB,E) 50 5 5
Rifampicin(RFP,R) 250 50 50
Aminothiourea(TB1) 100 10 1
Propylthiouracil (1321TH,PTH,TH) 100 25 25
Kanamycin(KM) 100 10 10
Capreomycin (CPM) 100 10 10
Cycloserine(CS) 40 20 20
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
Note: INH1, RFP50, SM20, EMB5, KM100, CPM100, 1321TH25, PAS1, CS40μg/ml are considered clinically ineffective when fully resistant; INH0 1, EMB2 5μg/ml are significantly less effective when fully resistant; PZA has not yet established a meaningful clinical method for checking resistance.
The BACTEC method is used for drug susceptibility testing of Mycobacterium tuberculosis, and because liquid medium and C14 isotopes are used to determine the metabolites of Mycobacterium tuberculosis to determine growth, the detection time is significantly shortened, and the results are consistent with the results of conventional modified Roche medium, which is often used in China. Recently, fluorescence and colorimetric techniques have been used to overcome radioactive contamination, and good results have been received.
3, sputum, BALF, pleural fluid tuberculosis polymerase chain reaction (PCR) + probe examination: because of the slow growth of tuberculosis bacteria, isolation and culture positive rate is not high, the need for rapid, sensitive and specific pathogenic examination and identification techniques. PCR is an in vitro DNA amplification technique of a specific nucleic acid sequence of M. tuberculosis mediated by a specific pair of oligonucleotide primers. It can increase the copy number of a specific nucleic acid sequence by millions of times in a short period of time, and on this basis, probe hybridization is performed to improve the sensitivity and specificity of detection. The results of the study showed that PCR+probe detection of sputum can obtain a significantly higher positive rate than smear microscopy and a slightly higher positive rate than culture, and it is time-saving and rapid, and has become an important reference for the etiological diagnosis of tuberculosis, but there are still some technical problems that need to be further solved.
4, serum anti-tuberculosis antibody test: serological diagnosis can become a rapid diagnostic aid for tuberculosis, but because of the lack of specificity and low sensitivity, further research is needed.
Diagnostic definition of bacillus-negative tuberculosis: bacillus-negative tuberculosis is tuberculosis with three sputum smears and one negative culture, and the diagnostic criteria are:
1, typical clinical symptoms of tuberculosis and chest x-ray performance.
2. Effective anti-tuberculosis treatment.
3. Other non-tuberculous lung diseases can be excluded clinically.
4, Strongly positive PPD (5TU); positive serum anti-tuberculosis antibody.
5, sputum TB bacillus PCR + probe test is positive.
6.Extrapulmonary histopathology confirmed tuberculosis lesion.
7.BALF detects acid-resistant branching bacilli.
8.Bronchial or pulmonary histopathology confirmed tuberculosis lesion. The diagnosis can be confirmed by having 3 of 1~6 or any 1 of 7~8.
V. Special populations and atypical tuberculosis Some special populations with tuberculosis may have many different characteristics from general tuberculosis patients in terms of symptoms, signs, chest X-ray manifestations and clinical history, which is called “atypical tuberculosis” and is more likely to delay the diagnosis. In order to attract clinical attention, the following cases are summarized.
In immune-compromised patients (patients with primary immunodeficiency diseases and patients treated with radiotherapy and immunosuppressive drugs), the symptoms of TB are insidious or mild due to interference or masking by corticosteroids or other immunosuppressive drugs and factors, and may lack respiratory symptoms.
The tuberculosis in immunocompromised patients is mostly hematogenous tuberculosis, combined with pleurisy or extrapulmonary tuberculosis, and the “pleomorphism” on X-ray is not obvious, but homogeneous flocculent shadows, which can occur in the non-tuberculosis sites, middle and lower lobes, and the anterior segment of the upper lobe, and should be differentiated from acute pneumonia.
3, extremely immunocompromised patients may first develop systemic symptoms such as high fever, invasion of the liver, spleen and lymph nodes, while the lung X-ray shadow appears significantly longer or for a long time as unresponsive tuberculosis without typical corn-like lesions (fulminant tuberculous sepsis).
4, AIDS combined with pulmonary tuberculosis can show enlarged hilar and mediastinal lymph nodes, infiltrative lesions in the lower and middle lung fields, similar to the primary tuberculosis, and combined with pleurisy and extra-pulmonary tuberculosis, PPD test (-) and other characteristics.
5, diabetes mellitus combined with pulmonary tuberculosis X-ray features mainly exudate cheese, can be large lamellar, giant lump, easy to form cavities, most likely in the hilar region and the lower and middle lung fields, rapid progress of lesions, should be noted and acute pneumonia, pulmonary sepsis, lung cancer differentiation.
6.Tuberculosis due to bronchial tuberculosis is mostly in the lower and middle lung fields or adjacent lung segments, and because of the presence of bronchial stenosis, it can often be combined with bacterial infection resulting in atypical lesion manifestations, which can be easily confused with pneumonia.
Sixth, the classification of tuberculosis (1999 classification standards of tuberculosis)
1, primary pulmonary tuberculosis: clinical conditions caused by primary tuberculosis infection, including primary syndrome and intrathoracic lymph node tuberculosis.
2, blood-borne tuberculosis: including acute blood-borne pulmonary tuberculosis (acute cornified tuberculosis) and subacute, chronic blood-borne pulmonary tuberculosis.
3, secondary tuberculosis: is a major type of tuberculosis, including infiltrative, fibrous cavity and caseous pneumonia, etc.
4, tuberculous pleurisy: clinically, other causes of pleurisy have been excluded. Including tuberculous dry pleurisy, tuberculous exudative pleurisy, tuberculous abscess chest.
5, other extra-pulmonary tuberculosis: named according to the location and organs, such as bone and joint tuberculosis, tuberculous meningitis, renal tuberculosis, intestinal tuberculosis, etc. In the diagnosis of pulmonary tuberculosis, the diagnosis can be written according to the above classification names, and the scope (left, right, bilateral), sputum bacteria and initial and repeated treatment should be indicated.
7. Common complications of pulmonary tuberculosis and treatment
Hemoptysis: the majority of cases indicate activity and progression of the disease, but a few can also occur when the tuberculosis has improved or stabilized. Hemoptysis in pulmonary tuberculosis is mostly due to the presence of exudate and cavitary lesions or bronchial tuberculosis and local tuberculosis lesions causing bronchial deformation, distortion and dilation. Hemoptysis in TB patients can cause serious complications such as asphyxia, hemorrhagic shock, pulmonary atelectasis, TB bronchial dissemination and aspiration pneumonia.
In case of hemoptysis, anti-tuberculosis treatment should be administered. In case of medium or large hemoptysis, active hemostasis should be performed to keep the airway open and to prevent asphyxia and hemorrhagic shock. General hemostatic drugs to improve coagulation mechanism are not effective in tuberculosis hemoptysis. Posterior pituitary hormone is still the most effective hemostatic drug in the treatment of pulmonary tuberculosis hemoptysis, which can be given as 5-10 U in 25% glucose 40 ml slowly by IV for 10-15 min. 10-20 U in 5% glucose 500 ml slowly by IV can also be used in non-emergency situations. Patients with contraindications to posterior pituitary hormone can be treated with phentolamine 10-20 mg in 25% glucose 40 ml for 10-15 min or 10-20 mg in 5% glucose 250 ml (pay attention to blood pressure). Tuberculosis with hemoptysis caused mainly by lesions in the middle and lower lung fields, and without diaphragmatic adhesions, can also be stopped by artificial pneumoperitoneal atrophy therapy. In recent years, interventional therapy with bronchial artery tethering for pulmonary tuberculosis hemoptysis has received recent good results.
2, spontaneous pneumothorax: tuberculosis is a common cause of pneumothorax. A variety of tuberculosis lesions can cause pneumothorax: subpleural lesions or cavities breaking into the chest cavity; tuberculosis lesions fibrosis or scarring leading to emphysema or rupture of the pulmonary blister; lesions of the corn type tuberculosis in the interstitium can also cause interstitial emphysema rupture of the pulmonary blister. When the lesion or cavity breaks into the chest cavity, the chest cavity commonly exudes more fluid, which can form liquid pneumothorax or pus pneumothorax.
For closed pneumothorax, lung compression <20%, no obvious clinical respiratory distress patients can use conservative therapy. For tension, open pneumothorax and closed pneumothorax not healed for more than 2 weeks, intercostal intubation water seal bottle drainage is commonly used, and for closed water seal bottle drainage not healed for more than 1 week, pleural effusion or abscess chest, intermittent negative pressure suction or continuous constant negative pressure suction is used, and the general negative pressure is: -10 ~ -14cmH2O (1cmH2O=0 098kPa).
3, pulmonary secondary infection: tuberculosis cavity (especially fiber cavity), pleural hypertrophy, tuberculosis fibrosis caused by bronchodilation, pulmonary atelectasis and airway obstruction due to bronchial tuberculosis, is the pathological basis for tuberculosis secondary to other bacterial infections. In the diagnosis of co-infection, a thorough analysis of body temperature, local? The diagnosis of co-infection should be based on a thorough analysis of body temperature, local sound, changes in sputum properties and quantity, peripheral blood picture, sputum bacterial culture results, and the pathological basis of the lung. Bacterial infections are often predominantly G bacilli and compound infections are common.
The long course of tuberculosis, the long-term use of antibiotics (such as streptomycin, amikacin, rifampin, etc.), the old age and frailty of some cases and the simultaneous application of immunosuppressive drugs can lead to secondary fungal infections. It is common to have Aspergillus globules in the cavity and bronchial dilatation cavity, and the chest X-ray shows a “crescent-shaped” change of the air cavity above the fungal globules in the cavity, surrounded by air bands and moving with body position. A few patients may have secondary Candida albicans infection.
Secondary infection should be different for the pathogen, the use of appropriate antibiotics or antifungal treatment.
Eight, the principles of tuberculosis treatment: early, regular, full, appropriate amount, combined five principles. The entire chemotherapy program is divided into two phases: intensive and consolidation. Most patients with pulmonary tuberculosis are treated without hospitalization and also receive good results. The key to successful chemotherapy without hospitalization lies in effective treatment management of TB patients, i.e., directlyobservedtreatmentshort course (DOTS), which is currently implemented under the direct supervision of medical staff to ensure regular, combined, adequate and uninterrupted treatment of TB patients throughout the course. The DOTS (directlyobservedtreatmentshort course) ensures that patients with tuberculosis are treated with regular, combined, adequate and interrupted chemotherapy throughout the course of treatment to reduce the development of drug resistance and ultimately achieve a cure.
Since patients have different tolerance to anti-tuberculosis drugs, different liver and kidney function (especially in elderly patients) and the presence of multidrug-resistant tuberculosis (MDR TB), the treatment should also be individualized to ensure the successful completion of chemotherapy and increase the rate of sputum negative for drug-resistant tuberculosis.
1. Treatment of primary TB: Definition: Patients who have one of the following conditions are considered to be in primary treatment: ① Patients who have not started anti-tuberculosis treatment; ② Patients who are on standard chemotherapy regimen and have not completed the course of treatment; ③ Patients who have not completed 1 month of irregular chemotherapy.
Primary treatment regimen: 2 months of intensive period / 4 months of consolidation period. The number in front of the drug name indicates the number of months of drug administration, and the number at the bottom right of the drug name indicates the number of doses per week. Common regimens: 2S(E)HRZ/4HR; 2S(E)HRZ/4H3R3; 2S3(E3)H3R3Z3/4H3R3; 2S(E)HRZ/4HRE; 2RIFATER/4RIFINAH (RIFATER: Weifet, RIFINAH: Weifenesin).
If the sputum smear is still positive at the end of the 2nd month of the initial intensive treatment period, the intensive regimen can be extended by 1 month, and the total course of treatment remains unchanged for 6 months (the consolidation period is shortened by 1 month). If the sputum smear is still positive at the 5th month and negative at the 6th month, the consolidation period will be extended by 2 months, and the total course of treatment will be 8 months. In the case of cornified tuberculosis (without tuberculous meningitis), the above regimen can be extended appropriately without intermittent treatment regimen, and the intensive period is 3 months, the consolidation period is 6-9 months for HR regimen, and the total duration of treatment is 9-12 months.
Patients with bacillus-negative tuberculosis may be treated by deleting streptomycin or ethambutol during the intensive phase of the above regimen.
2. Treatment of relapsed tuberculosis: Definition of relapsed treatment: Patients with one of the following conditions are considered to be relapsed treatment: ① patients who have failed initial treatment; ② patients whose sputum bacteria return after a full course of regular medication; ③ patients with irregular chemotherapy for more than 1 month; ④ patients with chronic bacillary excretion.
Regimen: 3 months of intensive period / 5 months of consolidation period. Commonly used regimen:2SHRZE/1HRZE/5HRE;2SHRZE/1HRZE/5H3R3E3;2S3H3R3Z3E3/1H3R3Z3E3/5H3R3E3.
Patients with relapsed treatment should have drug sensitivity tests, and for relapsed bacteriophage cases in which chemotherapy with the above regimen is ineffective, the chemotherapy regimen for multidrug-resistant tuberculosis can be referred to and adjusted according to drug sensitivity tests. The possibility of non-tuberculous mycobacterium infection should be alerted to those who have not been treated for a long time.
3, treatment of multidrug-resistant tuberculosis: TB that is resistant to at least two or more drugs, including INH and RFP, is MDR TB, so multidrug-resistant tuberculosis must have sputum tuberculosis drug sensitivity test results to confirm the diagnosis. The WHO recommends that a mixture of first-line and second-line antituberculosis drugs can be used for the treatment of MDR TB. In addition to INH and RFP, first-line drugs can be used according to the sensitivity of the case: ① SM: in the standard chemotherapy regimen, it is used only in the intensive period of 2 months. As the use of SM decreases, the number of SM-resistant cases may also decrease in some areas. Although the drug sensitivity test is difficult to confirm the drug susceptibility of M. tuberculosis to PZA (because there is no recognized reliable susceptibility test method), it is often used in the international chemotherapy regimen for MDR TB. EMB: The antibacterial effect is similar to that of SM, and the frequency of resistance of M. tuberculosis to it is low.
Second-line antituberculosis drugs are the mainstay of multidrug-resistant TB treatment, including ① aminoglycoside amikacin (AMK) and peptide coleomycin, etc. ②Thionamides: ethylthioisonicotinamide (1314TH), propylthioisonicotinamide. ③Fluoroquinolones: Ofloxacin (OFLX) and levofloxacin (LVFX) have synergistic effects with PZA on killing TB bacilli in macrophages, and have better safety and hepatic tolerance in long-term application. ④Cycloserine: It is toxic to the nervous system and its application is limited. ⑤ Sodium para-aminosalicylate: It is a bacterium inhibitor and is used to prevent drug resistance of other drugs. ⑥Rifabutin (RBT): Some of the RFP-resistant strains are still sensitive to it. Isoniazid p-aminosalicylate (PSNZ): It is an old drug, but some of the INH-resistant strains are still sensitive to it, and it is commonly used in the treatment of MDR.TB in China.
The WHO recommended chemotherapy regimen for MDR TB without (or lack of) drug sensitivity test results, but for clinical consideration, is AMK (or CPM) + TH + PZA + OFLX combination during the intensive phase, and TH + OFLX combination during the consolidation phase. The intensive phase is at least 3 months, and the consolidation phase is at least 18 months, for a total duration of 21 months or more. If the results of drug sensitivity tests are obtained before or during chemotherapy, the drugs can be adjusted on the basis of the above-mentioned drugs to ensure that there are more than 3 sensitive drugs. If the lesion is limited in scope, the sputum does not turn negative after 4 months of chemotherapy, or the patient is only sensitive to 2 to 3 less effective drugs, is resistant to other anti-tuberculosis drugs, and has indications for surgery, surgical treatment can be performed. The dose and side effects of commonly used anti-tuberculosis drugs and anti-tuberculosis fixed compound are shown in Tables 2 and 3.
Table 2 Dose and side effects of commonly used anti-tuberculosis drugs
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
Daily dose Intermittent therapy
Drug name Adult (g) Child Adult (g) Major toxic and side effects Usage
50kg >50kg (mg/kg) 50kg >50kg
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
Isoniazid (INH, H) 0.3 0.3 10-15 0.5 0.6 Hepatotoxicity 1 dose daily in a single dose
Streptomycin (SM, S) 0.75 0.75 15-30 0.75 0.75 0.75 Hearing impairment, vertigo, renal dysfunction
Hearing impairment, dizziness, renal dysfunction, allergic reaction once daily
Rifampicin (RFP, R) 0.45 0.6 10～20 0.6 0.6 Hepatotoxicity, gastrointestinal reactions, allergic reactions once daily before meals 2h dose
Rifapentine (RFT, L) 0.45 0.6 Same as rifampicin once a day, before or after meals
Pyrazinamide (PZA, Z) 1.5 1.5 20-30 2.0 2.0 Hepatotoxicity, gastrointestinal reactions, allergic reactions, hyperuricemia 1 time daily or divided into 2-3 doses
Ethambutol (EMB, E) 0.75 1.0 15～25 1.0 1.2 Visual impairment, visual field reduction 1 time daily
Propylthiouracil (PTH, TH)
0.75 1.0 10～20 Gastrointestinal reaction, taste metallic taste 3 times a day
Sodium p-aminosalicylate (PAS, P)
8.0 8.0 150～250 10 12 Hepatotoxicity, gastrointestinal reactions, allergic reactions divided into 3 doses per day
Amikacin (AMK, butylamine, kanamycin)
0.4 0.4 10～20 0.4 0.4 Same as streptomycin 1 time daily intramuscular injection
Capreomycin (CPM) 0.75 0.75 0.75 0.75 0.75 Same as streptomycin, electrolyte disorder 1 time daily intramuscularly
Ofloxacin (OFLX, O)
0.4 0.6 Hepatotoxicity, gastrointestinal reactions, allergy, photosensitivity reactions, CNS reactions, tendon reactions once daily or in 2 to 3 divided doses
Levofloxacin (LVFX, V)
0.3 0.3 Same as ofloxacin 1 time daily or 2 to 3 times daily
Isoniazid para-aminosalicylic acid salt (Paxin hydrazide, PSNZ)
0.6 0.9 Same as isoniazid in 2-3 times daily
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
Note: Twice a week, intermittent therapy refers to dosing days
Table 3 Anti-tuberculosis fixed compound dose and side effects
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Drug name Dose of each drug (mg) Duration of treatment (months) Daily dosage Method of administration Toxic and side effects
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
Isoniazid Rifampicin Pyrazinamide R120,H80 2 Body weight 50kg 4 tablets 1/day Same as isoniazid, rifampicin
(Weifet, RIFATER) Z502 60kg 5 tablets dose
Isoniazid Rifampicin R150,H100 4 3 tablets 1/day, dosed Same as isoniazid, rifampicin
(Weifenin, RIFINAH)
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
Note: Fixed compound is a compound preparation made of various drugs in a fixed dose ratio, such as a compound preparation composed of isoniazid, rifampin, pyrazinamide and isoniazid, rifampin, the names are Weifet and Weifenin respectively, the advantage of the compound preparation is that it is conducive to ensuring the combination and adequate amount of chemotherapy for patients and facilitating supervision and management
Nine, treatment management of tuberculosis patients to ensure that patients adhere to the regular use of drugs in the treatment process, the completion of the prescribed course of treatment is the key to the success of tuberculosis treatment, in this regard, effective management measures must be taken for patients under treatment, specific requirements are:
1, the management of the mouth: the current management of tuberculosis treatment has a more complete technical specifications, medical staff of tuberculosis control institutions must receive systematic training, and a person responsible for the management of the end, until cured. According to our regulations, medical and health units at all levels found tuberculosis patients or suspected tuberculosis patients, should promptly report to the local health care institutions, and refer patients to the tuberculosis control institutions for unified examination, supervision of chemotherapy and management.
2, supervised chemotherapy: tuberculosis prevention and treatment organizations to implement supervised chemotherapy management of sputum-positive tuberculosis patients, each dose should be carried out under the face of medical personnel, monitoring treatment. Bacteria-positive and bacillus-negative tuberculosis patients who cannot implement supervised management should also use home visits and home supervision to strengthen treatment management.
3, inpatient and non-inpatient treatment: TB patients are generally treated with non-inpatient chemotherapy, and TB hospitals are responsible for the inpatient treatment of patients with acute, critical and severe TB and patients with serious complications, comorbidities, drug side effects and multidrug resistance, etc. Patients who are not discharged from the hospital are transferred to a TB prevention institution to continue to supervise chemotherapy and complete the prescribed course of treatment.