TUBERCULOSIS MANAGEMENT

CHEMOPROPHYLAXIS

In close contact with sputum smear-positive TB who has not received at least 2 weeks’ anti-tuberculosis drug treatment should be treated as follows:

BCG+ve:	·Strong Mantoux positive (15 mm or greater) but asymptomatic, with normal CXR OR Mantoux (6-14 mm), IGRA( Interferon Gamma Release Assay) positive, asymptomatic, normal CXR
BCG –ve:	·Mantoux >6mm, asymptomatic, normal CXR

Isoniazid – 5 mg/kg od for neonates

Isoniazid – 10mg/kg/day (max 300mg)

Rifampicin – 10mg/kg/day(max 600 mg)

Pyrazinamide – 35mg/kg/day (max 2gram)

Ethambutol – 15mg/kg/day

Presentation	Treatment
Respiratory TB (lungs, pleural cavity, mediastinal lymph nodes or larynx)	Rifampicin & Isoniazid for 6 months Pyrazinamide & Ethambutol for 1st 2 months
Meningeal TB	Rifampicin & Isoniazid for 12 months Pyrazinamide & Ethambutol for 1st 2 months Prednisolone 1-2mg/kg max 40 mg, with gradual withdrawal of prednisolone, starting within 2–3 weeks of initiation
TB pericarditis	As for Respiratory TB plus prednisolone as above
Other extra pulmonary lesions	As for Respiratory TB

Initially monthly and then two monthly, repeat Chest X Ray at 3 and 6 months
If compliance is good and no residual clinical problems no need for follow up after completion treatment.