- •Lecture topic:
- •The goal of treatment of patients with tuberculosis is elimination of clinical signs
- •CRITERIA FOR THE EFFECTIVENESS OF TREATMENT OF TUBERCULOSIS PATIENTS:
- •THE MAIN COMPONENTS OF TREATMENT OF
- •CHEMIOTHERAPY – etiotropic (specific) treatment of patients aimed at destroying the mycobacterial population
- •PRINCIPLES OF CHEMOTHERAPY:
- •FACTORS INFLUENCING THE CLINICAL
- •4 POPULATION OF MYCOBACTERIUM TUBERCULOSIS IN THE FOCUS OF ACTIVE SPECIFIC INFLAMMATION:
- •TWO PHASES OF CHEMOTHERAPY:
- •2.The CONTINUING PHASE of treatment is aimed at the remaining, slowly multiplying mycobacterial
- •REGIMENS FOR TAKING ANTI-TB
- •WAYS OF ADMINISTERING
- •CLASSIFICATION OF ANTI-TB DRUGS (WORLD HEALTH ORGANIZATION, 1998):
- •2ND LINE DRUGS (RESERVE DRUGS):
- •3RD LINE DRUGS:
- •CHEMOTHERAPY REGIME
- ••drug resistance of MBT;
- •TYPES OF CHEMOTHERAPY REGIMENS:
- •I STANDARD CHEMOTHERAPY
- •IIa STANDARD chemotherapy regimen
- •IIb STANDARD MODE OF
- •III STANDARD CHEMOTHERAPY
- •VI STANDARD CHEMOTHERAPY
- •CHOOSING A CHEMOTHERAPY REGIMEN, IT IS NECESSARY TO:
- •CHOOSING A CHEMOTHERAPY REGIMEN, IT IS NECESSARY TO:
- •CHEMOTHERAPY REGIMENS (ACCORDING TO ORDER NO. 109 OF THE MINISTRY OF HEALTH OF
- ••Chemotherapy Mode IIA is prescribed to patients with relapsed pulmonary tuberculosis and patients
- •3.CHEMIOTHERAPY MODE IIB is used in patients with high risk of drug resistance
- •4.CHEMIOTHERAPY MODE III is administered to patients with newly diagnosed small forms of
- •From the clinical point of view, V.Y. Mishin's classification is the most justified,
- •Multidrug-resistant tuberculosis (as defined by the WHO) includes pathogens resistant to at least
- •COLLAPSOTHERAPY treatment by creating an artificial pneumothorax or artificial pneumoperitoneum.
- •VARIANTS OF THE FORMED ARTIFICIAL PNEUMOTHORAX:
- •BASIC INDICATIONS:
- •CONTRAINDICATIONS TO APPLICATION OF ARTIFICIAL PNEUMOTHORAX:
- •PARTICULAR (determine clinical form of the disease, prevalence or localization of the process,
- •COMPLICATIONS ASSOCIATED WITH THE APPLICATION OF AN ARTIFICIAL PNEUMOTHORAX:
- •COMPLICATIONS ARISING DURING MAINTENANCE OF ARTIFICIAL PNEUMOTHORAX:
- •ARTIFICIAL PNEUMOPERITONEUM
- •MECHANISMS OF CURATIVE ACTION OF ARTIFICIAL PNEUMOPERITONEUM:
- •Main indications for the use of artificial pneumoperitoneum (according to I.A.
- •GENERAL
- •SPECIAL
- •COMPLICATIONS OF ARTIFICIAL
- •SURGICAL TREATMENTS.
- •3.Life-threatening complications and sequelae of tuberculosis have clinical manifestations and can lead to
- •POSSIBLE INDICATIONS
- •CONTRAINDICATIONS:
- •TYPES OF OPERATIONS:
- •8.Bronchial surgeries (occlusion, resection and plasty, stump reamputation).
- •PATHOGENETIC THERAPY –
- •Б. Hyaluronidase.
- •THANK YOU
REGIMENS FOR TAKING ANTI-TB
MEDICATIONS:
1.The optimal regimen for administering TB drugs is to administer the daily dose at a time.
2.In case of adverse reactions, the daily dose can be divided into 2 doses. In this situation, the intervals between doses should be minimal.
3.It is possible to use fractional administration of a daily dose of the drug or intermittent (intermittent) administration of a full dose (3 times a week), it is possible to increase the interval between doses of different drugs, to change the way of administration of the drug.
WAYS OF ADMINISTERING
ANTITUBERCULOSIS DRUGS:
1.Intravenously.
2.Intramuscular.
3.Intravenous (by drip or stream).
4.Endobronchial infusions.Inhalation of aerosols.
5.Rectal administration (enemas, suppositories).
CLASSIFICATION OF ANTI-TB DRUGS (WORLD HEALTH ORGANIZATION, 1998):
1ST LINE DRUGS (CORE):
Isoniazid (H)
Rifampicin (R)
Pyrazinamide (Z)
Etambutol (E)
Streptomycin (S)
2ND LINE DRUGS (RESERVE DRUGS):
Kanamycin (amikacin) (K)
Ethionamide (prothionamide) (Et, Pt)
Cycloserine (Cs)
Capreomycin (Cap) Aminosalicylic acid Fluoroquinolones (Fg)
3RD LINE DRUGS:
Clarithromycin Amoxicillin + clavulanic acid
Clofazimine
Linezolid
Combination antituberculosis drugs are two-, three-, four- and five-component drug forms with fixed doses of individual substances.
They are used both in acute process and in the phase of treatment.
CHEMOTHERAPY REGIME
– selection of the optimal combination of drugs, their doses, routes of administration, rhythm of administration, and duration of treatment.
The chemotherapy regimen is determined taking into account:
•character of regional drug sensitivity of MBT to antituberculosis drugs;
•epidemiological hazard (contagiousness) of the patient;
•nature of the disease (newly detected case, relapse, chronic course);
•the prevalence and severity of the process;
•drug resistance of MBT;
•the dynamics of clinical and functional indicators;
•dynamics of bacteriological excretion;
•involution of local forms in lungs (resorption of infiltration and closure of caverns).
TYPES OF CHEMOTHERAPY REGIMENS:
•Standard - is carried out by a combination of the most effective drugs. This choice is conditioned by the fact that determination of MBT drug sensitivity takes 2.5-3 months.
•Individual regimen is prescribed after receiving information about sensitivity of the pathogen, i.e. the therapy is adjusted.
I STANDARD CHEMOTHERAPY
REGIMEN
INTENSIVE PHASE OF |
CONTINUATION OF |
||||||
|
THERAPY PHASE |
||||||
|
THERAPY |
|
|||||
|
|
|
HR or H3R3 |
|
|||
|
|
|
|
|
|
||
|
HRZE or HRZS |
||||||
|
|
|
(4 month); |
||||
|
(2 month) |
|
|
||||
|
|
|
HE (6 month) |
||||
|
|
|
|
|
|
IIa STANDARD chemotherapy regimen
INTENSIVE PHASE OF |
|
CONTINUATION OF |
|
|
||||
|
THERAPY PHASE |
|||||||
|
THERAPY |
|
|
|
||||
|
|
|
||||||
|
|
|
|
|
|
|
|
|
HRZES (2 month); |
HRE or H3R3E3 |
|||||||
|
|
HRZE (1 month) |
|
|
|
(5 month) |
||
|
|
|||||||
|
|
|
|
|
|
|
|
|