MEDICAL MANAGEMENT

Treatment modalities
Treatment includes appropriate antibiotic therapy and vigorous supportive care.
I. The first line drugs for short course chemotheraphy (SCC) given for six to nine months are:
1. Isoniazid (INH) is the first line agent for all cases of TB, known or presumed. It has early
bactericidal activity against rapidly dividing cells.
2. Rifampicin (Rifadin, Remactane) is first line anti-TB agent that acts against rapidly dividing
organisms and semidormant bacteria.
3. Pyrazinamide (PZA) exerts greatest activity against dormant or semidormant organisms
contained within macrophages.
4. Ethambutol (EMB) prevents the emergence of rifampicin resistance when primary resistance
to INH is present. Ethambutol is not recommended for children when visual acuity cannot be
monitored.
II. The second line drugs for TB include:
1. Cycloserine/ethionamide is used to treat patients with drug resistant TB.
2. Streptomycin and ethambutol have approximately the same purpose when use during the
intitial phase
3. Patients with drug resistance may be given with the second line drugs such as preomycin,
cycloserine, amikacin, and quinolone
4. If the medicine is taken incorrectly, the patient may become resistant to the anti-TB drug.
This is very dangerous because if the disease recurs, it is harder to treat the second time
around.
III. The WHO recommends direct observed therapy (DOT) to prevent non-compliance. The health
care worker ensures that the patient takes his/her medications.
THE FIVE ELEMENTS OF DOTS
1. Political commitment with increased and sustained financing.
2. Case detection through quality assured bacteriology.
3. Standardized treatment, with supervision and patient support.
4. An effective drug supply and management system.
5. Monitoring and evaluation system, and impact measurement.

NURSING MANAGEMENT
Meningitis
1. Watch for deterioration of the patient's condition, which may signal for an impending crisis.
2. Monitor fluid balance. Maintain adequate fluid intake to prevent dehydration, but avoid fluid
overload because of the danger of cerebral edema. Measure central venous pressure as well as intake
and output.
3. Watch for adverse reaction of antibiotics and other drugs. Avoid IV infiltration and phlebitis by
assessing the site and changes
4. Maintain adequate nutrition and elimination.
5. Ensure the patient's comfort.
6. Provide reassurance and support to the patient and the family.

Tuberculosis
1. Maintain respiratory isolation until the patient responds to treatment or until he/she is no longer
contagious.
2. Administer medicines as ordered.
3. Always check the sputum for blood or purulent expectoration.
4. Encourage questions and conversations with patients and their families. Allow them to air their
feelings and raise their concerns.
5. Teach or educate patients and their families about TB, its course, and mode of transmission.
6. Teach the patient to cough or sneeze into tissue paper and dispose of the secretions properly.
7. Advise the patient to get plenty of rest and eat balanced meals.
8. Be alert on signs of drug reaction.
9. If the patient is receiving ethambutol, observe for optic neuritis. If it develops, discontinue the drug.
10. If the patient is taking rifampicin (Rifampin), observe for hepatitis and purpura. Assess the patient
for other complications like hemoptysis.
11. Emphasize the importance of regular follow-up examinations and instruct the patient and his/her
family to watch out for the signs and symptoms of recurring TB.