Management of Pulmonary Tuberculosis
The cornerstone of tuberculosis (TB) management is Directly Observed Treatment, Short-course (DOTS), utilizing a multi-drug regimen to ensure adherence and prevent drug resistance.
1. Standard Anti-Tubercular Therapy (ATT) Regimen
The standard regimen for new smear-positive pulmonary TB cases is divided into two phases:
| Phase | Duration | Drugs |
|---|---|---|
| Intensive Phase | 2 Months | HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) |
| Continuation Phase | 4 Months | HRE (Isoniazid, Rifampicin, Ethambutol) |
2. Key Pharmacological Pearls
- Isoniazid (H): Causes peripheral neuropathy; always supplement with Pyridoxine (Vitamin B6).
- Rifampicin (R): Causes orange/red discoloration of body fluids; potent inducer of hepatic enzymes.
- Pyrazinamide (Z): The most common cause of hyperuricemia and potential gout.
- Ethambutol (E): Associated with dose-dependent optic neuritis; monitor visual acuity and color discrimination.
NEET PG Hint: Remember that Rifampicin is the most powerful bactericidal drug, while Isoniazid is the most potent sterilizing drug. Always check liver function tests (LFTs) before and during therapy, as hepatotoxicity is a shared risk among H, R, and Z.