First-Line Treatment Regimen (6 months):
- Initial Phase (2 months): Rifampicin, Isoniazid, Pyrazinamide, Ethambutol (RIPE)
- Rationale: Combination therapy targets different bacterial populations to prevent resistance.
- Continuation Phase (4 months): Rifampicin, Isoniazid
- Rationale: Maintains suppression of persisting organisms.
- Drug-Resistant TB (MDR/RR-TB):
- MDR-TB: Resistant to Rifampicin + Isoniazid; requires 20-month regimen with fluoroquinolones, injectables (e.g., Kanamycin), and second-line drugs (e.g., Ethionamide).
- RR-TB: Resistant to Rifampicin only; treated similarly to MDR-TB.
- Key Principles:
- Directly Observed Therapy (DOT): Ensures adherence to prevent resistance.
- Dormant TB: Latent TB requires Isoniazid for 6–9 months or Rifampicin for 4 months.
- Monitoring:
- Sputum culture conversion: Assesses treatment response.
- Adverse effects: Monitor for hepatotoxicity (e.g., Rifampicin, Isoniazid), ototoxicity (injectables), and peripheral neuropathy (Isoniazid).
- Surgical Considerations:
- Indicated for complications (e.g., spinal TB with instability) or drug-resistant cases.
- Post-surgical recovery often allows return to work (e.g., 57% in historical data).
- Diagnosis:
- Molecular tests (e.g., GeneXpert MTB/RIF): Rapid detection of TB and Rifampicin resistance.
- Culture: Gold standard for drug susceptibility testing.
- Public Health Role:
- Isolation for infectious cases until non-infectious (e.g., negative sputum cultures).
Rationale: Slow replication and natural resistance require prolonged, multi-drug regimens to eradicate all bacterial populations.