Suspect Tuberculosis in ever case of:
Cough > 15 days, cough not responding to antibiotics, cough not responding to antibiotics, cough with copious expectoration, cough with slightest hemoptysis, cough in HIV positive patient.
Fever not responding to antibiotics and anti-malarials.
Severe Anorexia.
Emaciation or loss of weight.
Cough or fever in relatives of a sputum positive patoent.

Ask for:
Hb, WBC,ES, Sputum AFB, X-ray chest.
HIV test in every case of Tuberculosis.
Sputum culture and sensitivity if no response to treatment.
In doubtful cases for supportive evidence.
Tuberculin test.
TB 1gG anf Tb1gM
Bronchosapiration for AFB

Treatment

General Instructions

Complete bed rest at home, till the patient is on way to recovery. No exertion and minimum talking to rest the lungs.
No smoking.
As long as, sputum AFB is positive, Isolation inhouse, Avoid contact with children, Cover the mourth while coughing handkerchief, and destroy sputum.
Good Nutritious, Protein rich food, Avoid oily and fried foods if cough.

Anti TB Chemotherapy

Recommended regimes:

Uncomplicated new case, early infiltration, AFB negative, or a simple pleural effusion: RHEZ for 2months + RHE for 4 months. If at the end of 6 months the lesions are not completely cleared continue RHE upto 9 months.

Fresh case with extensive infiltration (involves more thatn half lung, or bilateral) or with cavitation, or AFB positive: SRHEZ for 2 months + RHE 7 -10 months till cure.

Complicated case, Relapsed cases: SHREZ for 3 months + RHE till cure. If there is no adequate response after 3 months treatment. Then ask for sputum culture sensitivity. And consult chest physician for MDR-TB.

Prescription

S=Inj. Streptomycin: 40mg.kg.day. Ambistryn 1g (0.75g) IM daily x 30 The daily or alternate daily x 60 Injections. Stop if giddiness.

H=Tab. Isonazide 5-10gm/kg/day. ISOKIN 300mg. (300mg) 1 daily x till cure.

R=Cap. Rifampicin: 10mg/kg/day Rimactane 450mg. (300mg) 1 daily x early morning on empty stomach x till cure stop if jaundice.

E=Tab. Ethambutol: 15mg/kg/day Myambutol 800mg. (600mg). 1 at bed time after night meal x till curse.
Z=Tab. PYRAzinamide: 30mg.kg.day. PZA 750mg. (500mg). 2tabs daily x 2 months.
K=Inj. KANAMYCIN:
Kancin 0.5mg  IM x 2 times/week

Ancillary treatment:

If patient is pale: Give Iron eg. Cap. Autrin 1 daily x 3 months.
If patient is breathless, Give bronchodilaters
e.g. Tab. ASTHALIN 4mg x tds
Syp. Bronchopyllin tsp tds(5D)
If patient has cough, Give expectorants eg. Soventol expectorant tsp tds.
If patienthas hemoptysis, Give hemostatic drugs + antibiotics.
Cap. Bacilox 500mg tds x 5 days.
Inj, Stradrene IM or Dicynene I.V.
Inj. Calcium gluconate 10cc I.V. daily.

Strict Bed rest alone has cured millions of patients in the past, while no modern drug can do it alone. Bed rest is a strong weapon against TB. Use it.

Streptomycin gives the best symptomatic relief in early phase of treatment. If response to oral 4 drug therapy is not satisfactory, try streptomycin.

The most important role of a General Practioner in treatment of TB is in encouraging the patient to take full course of treatment, till TB is cured.

If X-ray is picture shows no improvements with treatment look for 1. Anemia 2. HIV test 3. Blood sugar. 4. Is the patient taking drugs regularly. 5. Advise complete and strict bed rest.

If patient is pregnant. 1. Stop streptomycin and PZA. 2 Give INH and Ethambutol 3. Give Rifampicin and Kancin, with the due risk, If disease is extensive.

If patient gets jaundice, stop all drugs and treat jaundice. Then start treatment without Rifampicin and PYRAzinamide.

Inj. Streptomycin
Tab. Isonazide
Cap. Rifampicin
Tab. Ethambutol
Tab. PYRAzinamide
Inj. KANAMYCIN
Cap. Autrin
Soventol expectorant
Cap. Bacilox
Inj, Stradrene IM
Dicynene I.V
Inj. Calcium gluconate