RIRIN SEPTEMI

010.06.0040
djois
Tuberkulosis penyakit yg disebabkan oleh Mycobacterium
Tuberculosis Complex.

Mycobacterium Tuberculosis Complex.
1. M. tuberkulosae
2. Varian asian
3. Varian african I & II
4. M. Bovis







S
E
B
A
R
A
N
SEBARAN
INFEKSI
MYCOBACTERIUM
TUBERCULOSIS
HEMATOGENIK
LIMFOGENIK
djois
MYCOBACTERIUM
TUBERCULOSIS
( PENGECATAN
ZIEHL NEELSEN )


BATANG
AGAK BENGKOK
RANTAI MANIK2
( BEADED )
5m x 0.2-0.6 m
djois

Berdasarkan Terapi membagi TB mnjadi 4,yaitu

Kategori - 1 : Px baru TB paru BTA positif
Px BTA neg. dg Ro. lesi luas
Px ekstra paru berat

Kategori - 2 : - Relapse (kambuh)
-Kasus gagal dng sputum BTA (+)

Kategori - 3 : BTA (-) dng Kelainan paru yg
tdk luas

Kategori - 4 : TB Chronic

K
o
m
p
l
i
k
a
s
i

Koplikasi dini
1. Pleuritis
2. Efusi pleura
3. Empiema
4. Laringitis
Koplikasi lanjut
1.Obstruksi jln nafas (sidrom
obstruksi pasca Tuberkulosis ),
2. Kerusakan parenkin berat
(Fibrosis paru, karsinoma paru,
Sindrom gagl nafas
TB TB treatment
regimens
Diagnostic TB patients Initial phase
Continuing phase
Category (daily or 3 times (daily or
3 times
weekly)
weekly )
I New smear-positive patients; 2 HRZE 4 HR
New smear-negative PTB with or
extensive parenchymal 6 HE daily
involvement;
Severe concomitant HIV disease
or severe forms of EPTB

II Previously treated sputum 2 HRZES/ 5 HRE
smear-positive PTB: 1 HRZE
- relaps;
- treatment after interruption;
- treatment failure
TB TB treatment
regimens
Diagnostic TB patients Initial phase
Continuing phase
Category (daily or 3 times (daily or
3 times
weekly)
weekly )
III New smear-negative PTB 2 HRZE 4 HR
( other than in category I); or
Less severe forms of EPTB 4 HE daily



IV Chronic and MDR-TB cases Specially designed standarized
( still sputum-positive after or individualized regimens are
supervised re-treatment) suggested for this category

* Menyembuhkan penderita TB
* Mencegah dan aktif TB
* Mencegah relaps
* Transmisi TB


Effective Anti TB drug


Short Course Chemotherapy

OAT

Action

Potency

Dose mg/Kg/BB
Daily Intermittent
3X 2X
INH (H)
RIF (R)
PZA (Z)
Strep (S)
Etham (E)
Bactericidal
Bactericidal
Bactericidal
Bactericidal
Bacteriostatic
Hight
Hight
Low
Low
Low
5
10
25
15
15
10
10
35
15
(30)
15
10
30
50
15
INH Membunuh 90%
Active thdp metabolic active
RMP Membunuh semi Dormant
PZA Membunuh bakteri dlm suasana asam
EVALUASI HASIL PENGOBATAN :
* Dahak SP
1=> akhir fase intesnsif
2=> akhir pengobatan
menentukan pengobatan selanjutnya
1.Akhir fase intensif :
+ - : terapi fase lanjtutan.
+ + : sisipan 1 bulan, ulang SP lanjt.
- - : terapi fase lanjtutan
- + : gagal terapi kat-2
2.EVALUASI DAHAK AKHIR PENGOBATAN

+ - + : gagal
+ + :sisipan, +/- : f. lanjt,+ : gagal
+ + :sisipan, - : sembuh
- - :fase lanjutan + : gagal
- + : gagal



WAKTU PEM DAHAK ULANG & TINDAK LANJUT
KAT. I
(2RHZE / 4 RH
atau 4R
3
H
3
)
Akhir fase
intensif
Sebulan
sebelum
AP
atau AP
NEG
POS
NEG
keduanya
POS
Teruskan tx
ke fase lanjutan
(4RH atau 4R
3
H
3
)
Tx sisipan
1 bulan
(1RHZE)
SEMBUH
GAGAL
Tdk ada
spesimen
PENGOBATAN
LENGKAP
BTA NEG
BTA +
WAKTU PEM DAHAK ULANG & TINDAK LANJUT
KAT. II
(2RHZES - 1RHZE/
4 RHE atau
4R3H3E3)
Akhir fase
intensif
Sebulan
sebelum
AP
atau AP
NEG
POS
NEG
keduanya
POS
Teruskan tx
ke fase lanjutan
(4RHE atau 4R
3
H
3
E
3
)
Tx sisipan
1 bulan
(1RHZE)
SEMBUH
KRONIK
Tdk ada
spesimen
PENGOBATAN
LENGKAP
WAKTU PEM DAHAK ULANG & TINDAK LANJUT
KAT. III
(2RHZ / 4 RH
atau 4R
3
H
3
)
Akhir
fase
intensif
NEG
POS

Teruskan tx
ke fase lanjutan
(4RH atau 4R
3
H
3
)
GAGAL