Poor Case Holding Case Summary

Case Holding
- Ensures treatment compliance
- Indirectly, this will translate to treatment success or cure
- Poor treatment compliance may lead to the following outcomes: o Chronic infectious illness o Drug resistance o Death

Poor Case Holding
1. Inadequate drugs and poor drug distribution
2. Patient’s non-adherence
3. Physician’s non-adherence
4. Low motivation of health workers

SLU PPMD Unit: Operations

PTB Suspect
- Cough > 2 weeks with or without the following o Fever o Hemoptysis o Back pains o Weight loss o Easy fatigability

Refer to SLUPPMD unity for sputum AFB smear
↓
PTB

Yes No
↓ ↓
Treat Refer to TBDC
↓
Send back to referring physician
- Importance of taking the drug
- Role of treatment
Pulmonary TB
a. Smear positive o >2 (+) sputum AFB + radiographic abnormalities consistent with TB, OR o 1 (+) sputum AFB + radiographic abnormalities consistent with active TB as determined by a physician, OR o 1 (+) sputum AFB + sputum culture (+) for MTB
b. Smear negative o > 3 (-) sputum AFB with radiographic abnormality consistent with active PTB, AND o no response to a course of antibiotics, AND o TBDC decides to treat the patient

2. Extra-Pulmonary TB (EP)
a. A patient with at least one mycobacterial smear/culture positive from an extra-pulmonary site, OR
b. A patient with histological &/or clinical evidence consistent with active extra-pulmonary TB and there is a decision by the TBDC to treat the patient with anti-TB drugs.
- Note: All EP cases shall undergo DSSM prior to treatment

Types of TB Cases
- New – no Tx or 2 months
- Treatment failure – still (+) on the 5th month
- Other – became (+) on 2nd month; interrupted Tx but smear (-)

Recommended Category of Treatment Regimen
Category Type of TB Patient TB Treatment Regimen Intensive Continuation
I New smear (+) PTB
New smear (-) PTB with extensive parenchymal lesion on CXR (TBDC)
EPTB and severe concomitant HIV disease 2HRZE
Rotate sites.
Burning sensation in the feet due to neuropathy INH Pyridoxine 100-200 mg/day for treatment; 10 mg for prevention
Arthralgia due to hyperuricemia PZA Give ASA/NSAID
Flu-like symptom Rifampicin Give antipyretics
Major
Severe skin rash Any (especially Streptomycin) Discontinue anti-TB drugs and refer to DOTS physician
Jaundice RHZ Discontinue anti-TB drugs and refer to DOTS physician
Impairment of visual acuity – optic neuritis EMB Discontinue EMB and refer to ophthalmologist
Hearing impairment Streptomycin Discontinue streptomycin and refer to DOTS physician
Psychosis and convulsion INH Discontinue INH and refer to DOTS physician
Thrombocytopenia, anemia and shock Rifampicin Discontinue anti-TB drugs and refer to DOTS