Because TB is transmitted via respiratory droplet, a high efficiency particulate air respirator (HEPA) mask must be used, along with placement in negative pressure room. Health care providers are fitted for proper mask size.
The acronym RIPE can be used to remember the four major first line TB medications: rifampin, isoniazid (INH), pyrazinamide, and ethambutol. Fluoroquinolones and aminoglycosides may be used with multidrug resistant tuberculosis (MDR-TB).
Initial phase of drug therapy is usually with four drugs during the first 2 months. The continuation phase of drug therapy may be with just 2 medications (INH and rifampin).
Directly observed therapy (DOT) is the best strategy to ensure that possible noncompliant patients take their TB medications, as they are watched while swallowing the medications.
Typically not administered to infants or individuals in the USA; however, other countries that have an increased incidence of TB use it. Be sure to ask the patient if they have ever received the vaccination, as their TB skin test will be positive and they should not receive a TB skin test. Patients who receive the BCG vaccine typically show a positive PPD for up to 10 years.
Patients should not consume alcohol as TB medications can lead to liver toxicity. Proper education given to the patient regarding the importance of following medication prescriptions is imperative for successful eradication of the organisms.
Patients are considered noninfectious during drug therapy when 3 consecutive sputum specimens are negative. Sputum specimens are collected every 2 to 4 weeks throughout the drug therapy regime. Patients are cleared to return to work after 3 negative specimens.
Teach patients to cover their mouth and nose when coughing and to use a plastic bag for used tissues. Close family members are tested and may be placed on prophylactic TB medication. Patients should sleep alone until noninfectious. Avoid public and crowded settings until noninfectious or wear a regular surgery mask when in public.
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