Posted: March 30th, 2022

The NICE (National Institute for Health and Care Excellence) guidelines

Starting and maintenance regime for Mr. chavda

The NICE (National Institute for Health and Care Excellence) guidelines aim to improve TB spread ways. Antituberculosis is divided into intensive (initial) and a continuation phase. The initial stage seeks to eliminate the majority of organisms and prevent drug resistance rapidly, and the continuation phase is to eradicate dormant organisms. Direct observational therapy should be incorporated in case management to ensure treatment adherence.

Start the patient on Isoniazid (with pyridoxine), rifampicin, pyrazinamide and ethambutol for two months. Once TB is known to be fully susceptible, ethambutol is discontinued, then Isoniazid (with pyridoxine) and rifampicin for a further four months.

Patients taking pyrazinamide should undergo baseline and periodic serum uric acid assessments, and those taking ethambutol should undergo baseline and visual acuity and red-green colour perception testing

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In case of isoniazid résistance, discontinue it and continue treatment with rifampin, pyrazinamide and ethambutol for six months. Therapy is extended if the patient has a cavitary disease and remains culture positive for two months after two months of treatment.

Isoniazid is used in combination with rifapentine. It inhibits the synthesis of mycolic acid resulting in disruption of bacterial cell wall .pyridoxine 25-50 mg once daily should be co-administered to prevent peripheral neuropathy.

Dosage: 5mg/kg PO/IM a day don’t exceed 300mg a day

Monitor for adverse effects, e.g. nausea and vomiting. Loss of appetite.

65kg (current weight for Mr Chavda) times 5mg =325mg, so administer 300 mg as per NICE guidelines.

 

Rifampin. Used in combination with at least one anti-TB drug for the treatment of active TB. It inhibits DNA dependent RNA polymerase activity in bacterial cells. In most sensitive cases patient undergoes six months of treatment but may last nine months if the patient’s sputum is positive after two months.

Adult dosage: 10mg/kg/day PO (peroral) or PO twice weekly DOT not to exceed 600mg/day

It May be given in conjunction with Isoniazid (INH) and pyrazinamide

65 times 10=650mg administer 600 mg for Mr. chavda

 

Pyrazinamide: this is a pyrazine analogue of nicotinamide that is either bacteriostatic or bactericidal against M tuberculosis. It is administered for initial two months 

Adult daily therapy: 15-30mg/kg/day not to exceed 2g/day

15 times 65=975g for Mr. Chavda daily

Twice weekly therapy 50mg/kg PO twice weekly not to exceed 2g/dose

It May be used in combination with Isoniazid and rifampinEthambutol: diffuses into mycobacterium cells, hindering cell metabolism by inhibiting the synthesis of 1 or more metabolites.

Adult dosage: daily administration

40 -55 kg: 800mg PO

56-75KG: 1.2g PO

  Above 75 kg 1.6 k.g

In case of combination therapy is used in Mr Chavda, the medical practitioners can utilise the FDCs (fixed-dose combination) schedule. FDCs are classified according to body weight, thus ensuring doses remain within therapeutic margins. For every drug, there is a therapeutic range that is effective and not toxic.

FDCs are improved formulations of a combination of two or more first-line anti TB drugs. These are rifampicin, isoniazid,pyrazinamide and ethambutol.

The schedule below shows dosage schedules for adults.

 

 

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