What should I do if my client has tuberculosis (TB)?
The topics include but are not limited to the following: 1) how TB is spread; 2) how to prevent the spread of TB; 3) how to take medications; 4) the effects of TB if not adequately treated; 5) the importance of completing the prescribed course of treatment; 6) the patient’s responsibility in curing his or her own disease; 7) the consequences to the individual if he or she is unwilling to …
What are the treatment standards for tuberculosis (TB) disease?
1) The department or a local health officer may petition any court for a hearing to determine whether an individual with infectious or suspect tuberculosis should be confined for longer than 72 hours in a facility where proper care and treatment will be provided and spread of the disease will be prevented.
What is the purpose of commitment to TB treatment?
The next step is to start treatment for latent TB infection or TB disease based on test results. Fortunately, there are several treatment options for people living with HIV who also have latent TB infection or TB disease. Consult with your health care provider or state or local health department for treatment options. Latent TB Infection and HIV
What is TB case management and treatment plan?
Tuberculosis (TB) is an airborne infectious disease that is caused by Mycobacterium tuberculosis. Laws to prevent and control TB have been in use for more than a century, and remain highly relevant today. The Centers for Disease Control and Prevention, in cooperation with its partners, developed or facilitated development of law-related ...
Can you force TB treatment?
Where the health officer determines that the public health or the health of any other person is endangered by a case of tuberculosis, or a suspected case of tuberculosis the health officer may issue any orders he or she deems necessary to protect the public health or the health of any other person, and may make ...
What is continuation phase in TB treatment?
Regimens for treating TB disease have an intensive phase of 2 months, followed by a continuation phase of either 4 or 7 months. The continuation phase should be extended to 28 weeks for patients who have cavitation on the intensive chest film and positive sputum cultures after 2 months of treatment.
What are the management steps for TB?
How Is Active TB Treated? If you have an active TB disease you will probably be treated with a combination of antibacterial medications for a period of six to 12 months. The most common treatment for active TB is isoniazid INH in combination with three other drugs—rifampin, pyrazinamide and ethambutol.
How can TB treatment adherence be improved?
Several interventions were found effective in improving medication adherence and outcomes of active TB patients, i.e. DOT by trained community members, SMS combined with TB education, a reinforced counselling method, monthly TB voucher, drug box reminder and a combination drug box reminder and text messaging.
WHO TB treatment guidelines?
Standards for treating drug-susceptible TB The initial phase should consist of 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol. The continuation phase should consist of 4 months of isoniazid and rifampicin. Daily dosing should be used throughout treatment.
What should we do after TB treatment?
People with TB disease need to take several medicines when they start treatment. After taking TB medicine for several weeks, a doctor will be able to tell TB patients when they are no longer able to spread TB germs to others. Most people with TB disease will need to take TB medicine for at least 6 months to be cured.
What is first line treatment for TB?
Of the approved drugs, isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA) are considered first-line anti-TB drugs and form the core of standard treatment regimens (Figure 6.4) (Table 6.2). Rifabutin (RBT) and rifapentine (RPT) may also be considered first- line drugs under certain circumstances.
How do you monitor TB treatment?
Monitoring response to treatment is done through regular history taking, physical examination, chest radiograph and laboratory monitoring. The classic symptoms of TB – cough, sputum production, fever and weight loss – generally improve within the first few weeks.
What is triple treatment for TB?
The commanding and lasting outcome: “triple therapy,” which included oral isoniazid together with PAS for 18 to 24 months, plus intramuscular streptomycin for the first 6 months (29). All together, “triple therapy” remained the standard treatment for all forms of tuberculosis for nearly 15 years (21).
Why is patient compliance an issue with tuberculosis patients?
The most serious problem hindering TB treatment and control is noncompliance of patients. It is believed to delay sputum conversion to smear negative, increase the relapse rates 5-6 times, and help the emergence of resistant mutant strains [4,5].
Why is medication compliance important in TB?
Poor treatment adherence (poor compliance) means that people remain infectious for longer and are more likely to relapse and die. It also contributes to the emergence of drug-resistant tuberculosis.
Why is non compliance during TB therapy such a big concern?
Non-adherence to anti TB treatment results in increased length and severity of illness, death, disease transmission and drug resistance.
What are the barriers to treatment for TB?
Patients with TB often face issues that complicate and can act as barriers to treatment, such as substance abuse, homelessness, unemployment, and lack of healthcare access. Effective case management may obviate the need for legal interventions.
What is the goal of a tuberculosis treatment plan?
The goal of the treatment plan is to achieve treatment to cure by the least restrictive means.
What is LTBI treatment?
The final two bullets address treatment for latent tuberculosis infection (LTBI). Treatment of LTBI is generally initiated after the possibility of TB disease is excluded, and has been proven to greatly reduce the risk that individuals latently infected with TB will progress to TB disease.
What is direct observation therapy?
1) Health care providers may prescribe DOT as a method to monitor the adherence of a patient to his or her prescribed treatment for tuberculosis disease. Health care providers may utilize the Department’s TB Standards of Care as a guideline for appropriate utilization of DOT.
How often does DOT have to be done?
The provision of DOT on a daily, twice weekly or three times weekly basis shall continue until discontinued by the health care provider.
What is the duty of a person with tuberculosis?
If, upon examination, it shall be determined that such person has tuberculosis in an active stage or in a communicable form, then it shall be the duty of such [person with tuberculosis] to arrange for admission of himself or herself as a patient in some medical care facility qualified to treat persons with tuberculosis or when there is no danger to the public or to other individuals as determined by the health officer, such person may receive treatment on an outpatient basis. Kan. Stat. Ann. § 65-116b (2009).
What is the responsibility of a health officer for testing for tuberculosis?
The health officer shall: 1) Direct that testing for tuberculosis infection using a Centers for Disease Control and Prevention approved method be performed on contacts of cases of tuberculosis in a communicable stage. 2) Recommend appropriate treatment for latent tuberculosis infection; and 3) Provide for the supervised presumptive treatment of latent tuberculosis infection for a child younger than 4 years old identified as a close contact to a confirmed case or suspected case of active pulmonary tuberculosis. Md. Code Regs. 10.06.01.21 (2009).
What does it mean when someone has been counseled about tuberculosis?
That the person who has active tuberculosis has been counseled about the disease, the threat to the public health posed by tuberculosis, and methods to minimize the risk to the public, and, despite such counseling, indicates an intent by words or action to expose the public to active tuberculosis; and.
How long can you be confined to a hospital for tuberculosis?
1) The department or a local health officer may petition any court for a hearing to determine whether an individual with infectious or suspect tuberculosis should be confined for longer than 72 hours in a facility where proper care and treatment will be provided and spread of the disease will be prevented.
What happens if a person does not comply with the terms and conditions of his conditional discharge?
If a person does not comply with the terms and conditions of his conditional discharge, he shall be subject to any of the procedures for involuntary treatment, including but not limited to the issuance of an order for protective custody. A conditionally discharged person who is confined pursuant to any of these involuntary procedures shall have all rights of a person committed involuntarily, including the right to periodic reports and review and an annual hearing pursuant to the provisions of this Part. La. Rev. Stat. Ann. § 40:31.28 (2009).
What is the definition of hospitalization, placement, and residential isolation?
1) Subject to the provisions of subsections 2) and 3), the department may petition the circuit court to order a person who has active tuberculosis to be hospitalized, placed in another health care facility or residential facility, or isolated from the general public in the home as a result ...
How long can you be discharged for tuberculosis?
A person who is committed to a treatment facility for active tuberculosis may be conditionally discharged for a period of up to one year by the director, upon the recommendation of the state health officer or his designee, or by a court of competent jurisdiction after a hearing.
How long can a conditional discharge last?
The director, upon the recommendation of the state health officer or his designee, or the court may extend the conditional discharge of a person for a period of up to two years and the person may be required to report for outpatient treatment as a condition of his release.
Where do you send a copy of a conditional discharge?
If the person is conditionally discharged by the court, a copy of the conditional discharge shall be sent to the director of the treatment facility to which the person has been committed, the state health officer or his designee, and the committed person’s counsel of record.
When should antiretroviral therapy be initiated?
Anti-retroviral therapy should ideally be initiated within the first 2 weeks ...
What is the first step in HIV testing?
The first step is to ensure that people with HIV are tested for TB infection. If found to have TB infection, further tests are needed to rule out TB disease. The next step is to start treatment for latent TB infection or TB disease based on test results.
How long does it take to take isonaizid and rifapentine?
Twelve weeks of once-weekly isonaizid and rifapentine (3HP), given by self-administered therapy or directly observed therapy, is the newest CDC-recommended treatment regimen for persons with latent TB infection and HIV and who are taking antiretroviral medications with acceptable drug-drug interactions with rifapentine.
How long does isoniazid last?
For those taking antiretroviral medications with clinically significant drug interactions with once-weekly rifapentine or daily rifampin, nine months of daily isoniazid is an alternative treatment. for more information on the drug interactions.
What is the phase of isoniazid?
An intensive phase of isoniazid (INH), a rifamycin (see Drug Interactions below), pyrazinamide (PZA), and ethambutol (EMB) for the first 2 months. A continuation phase of INH and a rifamycin for the last 4 months.
How long does HIV treatment last?
In the uncommon situation in which HIV-infected patients do NOT receive antiretroviral therapy during TB treatment, prolonging treatment to 9 months (extend continuation phase to 7 months) is recommended. Prolonging treatment to 9 months (extend continuation phase to 7 months) for HIV-infected patients with delayed response to therapy (e.g., ...
What is DOT therapy?
Directly observed therapy (DOT) and other adherence promoting strategies should be used in all patients with HIV-related TB. The care for HIV-related TB should be provided by, or in consultation with, experts in management of both TB and HIV. The care for persons with HIV-related TB should include close attention to adherence to both regimens of TB and antiretroviral treatment, drug-drug interactions, paradoxical reaction or Immune Reconstitution Inflammatory Syndrome (IRIS), side effects for all drugs used, and the possibility of TB treatment failure or relapse.
What is a TB control officer?
TB Control Officer. A person appointed by the state to be responsible for the administration of state TB programs.
Why is tuberculosis treated differently than other airborne infectious diseases?
Because of its communicable nature, tuberculosis (TB) is treated differently than other airborne infectious diseases, as there are many state laws specific to the control of TB. Many of these laws predate the current public health recommendations for the prevention and control of TB.
What is CDC Form 72.9?
Cases are reported by all states to CDC using the Report of Verified Case of Tuberculosis (CDC Form 72.9). States should require health-care providers and allied professionals who diagnose TB or treat or otherwise care for TB patients to report confirmed or suspected cases to the appropriate health agency.
What was the purpose of the Plan for Disease Containment?
The Plan called for revision of state and local laws to "facilitate the cure of persons with infectious tuberculosis," (1).
How many cases of MDRTB were there in 1992?
From 1990 through 1992, CDC participated in investigations of outbreaks in hospitals and correctional facilities that involved nearly 300 cases of MDRTB. These patients had a mortality rate of 43%-89%.
When should penalties be levied for nonadherent behavior?
Penalties for nonadherent behavior should be levied only after the use of incentives, enablers, voluntary or ordered DOT, and commitment for inpatient management have failed to result in adherence to treatment.
When was the CDC's Strategic Plan for the Elimination of Tuberculosis published?
In 1989 , CDC published A Strategic Plan for the Elimination of Tuberculosis in the United States that was developed by the Advisory Committee (now Council) for the Elimination of Tuberculosis (ACET) (1).
How does TB control work in Seattle?
The work improves the community’s health and saves money by controlling the spread of TB, preventing outbreaks, and preventing the development of multi-drug resistant TB that can be very expensive to treat. In King County, 100 new cases of TB were reported in 2014. On average, more than two cases of active tuberculosis are diagnosed in King County each week. Another 100,000 residents are infected with TB, but the microbe lies dormant.
How long does it take to get TB treatment in King County?
If the patient takes the medication consistently, treatment will be completed in approximately four months.
How does TB spread?
TB usually affects the lungs, but can affect lymph nodes, bones, joints, and other parts of the body. A person with active TB in the lungs can spread the disease by coughing or sneezing. To learn more about signs, symptoms, and transmission of TB, visit the Centers for Disease Control and Prevention’s TB website.
Can TB come back?
To become cured, a patient must complete the entire treatment, even after they are no longer infectious. If the treatment is interrupted before the bacteria are completely eliminated, the TB could come back, possibly as a multi-drug-resistant strain. Multi-drug-resistant TB is even more dangerous because patients can be contagious for a longer time, the disease is more difficult to cure, and it requires a longer treatment course with drugs that cause more frequent side effects. Learn more about TB drug resistance here.
What is chapter 6 of the TB treatment guide?
This chapter provides guidance on the strategies for the treatment of multidrug- and extensively drug-resistant TB (M/XDR-TB), with emphasis on regimen design. The treatment of mono- and poly-drug-resistant TB is addressed in Chapter 6. The strategies described in this chapter are largely based on the recommendations from the 2011 update of Guidelines for the programmatic management of drug-resistant tuberculosis, which underwent systematic review and analysis of the evidence for best treatment practice (1).
Which group of drugs is the most effective in treating TB?
Group 3: Fluoroquinolones. Fluoroquinolones are often the most effective anti-TB drugs in an MDR-TB regimen. There are two important recommendations regarding fluoroquinolone use from the 2011 update of the Guidelines for the programmatic management of drug-resistant tuberculosis(1).
What is empiric TB?
This Handbook uses the term “empiric” to refer to the initiation of treatment prior to determination of a firm diagnosis of drug-resistant TB. Empiric regimens can be used for both standardized and individualized treatment strategies. For example, an empiric XDR regimen refers to the use of a regimen designed to treat XDR-TB before the diagnosis of XDR-TB is made.
What is the best group of anti-TB drugs?
Group 1: First-line oral agents. Group 1 anti-TB drugs, the most potent and best tolerated, should be used if there is good laboratory evidence andclinical history that suggests that a drug from this group is effective. For patients with strains resistant to low concentrations of isoniazid but susceptible to higher concentrations, the use of high-dose isoniazid may have some benefit (when isoniazid is used in this manner it is considered a Group 5 drug, see below). The newer rifamycins, such as rifabutin, have very high cross-resistance to rifampicin.
What are the different classes of anti-TB drugs?
The classes of anti-TB drugs have traditionally been divided into first- and second-line anti-T B drugs with isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin being the primary first-line anti-TB drugs. While this classification is used in this document, it also uses a system that classifies the drugs into five different groups. The five-group system is based on efficacy, experience of use, safety and drug class. WHO will be reviewing this five-group system in the next update of the guidelines for the management of MDR-TB in view of the new drugs being introduced and the emerging evidence on its safety and efficacy. The different groups are shown in Table 5.1. Not all drugs in the same group come from the same “drug class” or have the same efficacy or safety. For more information, see individual descriptions of each group in this section. Individual detailed drug information for all anti-TB drugs is provided in the drug information sheets of Part 3.
What is standardized treatment?
Standardized treatment:DRS data from representative patient populations are used to base regimen design in the absence of individual DST. All patients in a defined group or category receive the same regimen (see Chapter 4for risk groups for MDR-TB). Suspected MDR-TB should be confirmed by DST whenever possible.
How early can you start anti-TB treatment?
Antiretroviral therapy (ART) is recommended for all patients with HIV and drug-resistant TB, irrespective of CD4 cell-count, as early as possible (within the first eight weeks) following initiation of the anti-TB treatment (strong recommendation) (1). The drug dosage is usually determined by age and weight.
How long does TB treatment last?
Because of the increased incidence of resistant strains of TB, the disease must be treated for up to 24 months in some cases, but treatment typically lasts for 9-12 months. Isoniazid is the most common medication used for the treatment of TB, but other antibiotics are added to the regimen to obtain the best results.
How long does it take for a TB patient to be sent home?
If they're negative, he would be considered non-contagious and may be sent home, although he'll continue to take the antitubercular drugs for 9 to 12 months. A client is diagnosed with active TB and started on triple antibiotic therapy.
What is a client with a productive cough, chills, and night sweats suspected of having?
A client with a productive cough, chills, and night sweats is suspected of having active TB. The physician should take which of the following actions?
What is the primary TB infection?
A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the lungs. At this point, the bacilli are walled off and skin tests read positive. However, all but infants and immunosuppressed people will remain asymptomatic.
What is the primary stage of TB?
A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the lungs. At this point, the bacilli are walled off and skin tests read positive. However, all but infants and immunosuppressed people will remain asymptomatic. The general population has a 10% risk of developing active TB over their lifetime, in many cases because of a break in the body's immune defenses. The active stage shows the classic symptoms of TB: fever, hemoptysis, and night sweats.
How to identify tubercle bacilli?
The most commonly used technique to identify tubercle bacilli is acid-fast staining. The bacilli have a waxy surface, which makes them difficult to stain in the lab. However, once they are stained, the stain is resistant to removal, even with acids. Therefore, tubercle bacilli are often called acid-fast bacilli.
Why are elderly people at higher risk for TB?
Elderly persons are believed to be at higher risk for contracting TB because of decreased immunocompetence. Other high-risk populations in the US include the urban poor, AIDS, and minority groups. The nurse is teaching a client who has been diagnosed with TB how to avoid spreading the disease to family members.
What is the best treatment for TB?
The most common treatment for active TB is isoniazid INH in combination with three other drugs—rifampin, pyrazinamide and ethambutol. You may begin to feel better only a few weeks after starting to take the drugs but treating TB takes much longer than other bacterial infections.
How long does it take to treat TB?
The treatment for this type of TB takes much longer, 20 to 30 months to complete, and you may experience more side effects.
What is DOT therapy?
This means a healthcare worker will come to you to administer your medication and eliminate the concern of forgetting to take the treatment.
What are the side effects of TB?
While you are in treatment for active TB disease, you will need regular checkups to make sure your treatment is working. Everyone is different, but there are side effects associated with taking the medications, including: 1 Upset stomach, nausea and vomiting or loss of appetite 2 Tingling or numbness in the hands or feet 3 Itchy skin, rashes or bruising 4 Changes in your eyesight or blurred visions 5 Yellowish skin or eyes 6 Dark-colored urine 7 Weakness, fatigue or fever that for three or more days
How to protect yourself from a sneeze?
Until your healthcare provider tells you to go back to your daily routine, here are ways to protect yourself and others near you: Take your medicine exactly as the healthcare provider directed. When you cough, sneeze or laugh, cover your mouth with a tissue. Put the tissue in a closed bag and throw it away.
What are the symptoms of TB?
Yellowish skin or eyes. Dark-colored urine. Weakness, fatigue or fever that for three or more days. It is important to tell your doctor or TB nurse immediately if you begin having any unusual symptoms while taking medicine for either preventive therapy or for active TB disease.
What to take for TB tingling?
If you are having trouble with tingling and numbness, your doctor may prescribe a vitamin B6 supplement while you are in treatment. It may also be possible to change TB medications if your side effects are serious.