Tuberculose V – Soins collaboratifs

Drug-susceptible tuberculosis refers to TB strains sensitive to standard first-line anti-tuberculosis drugs like Isoniazid, Rifampin, Pyrazinamide, and Ethambutol. Drug-resistant tuberculosis occurs when patients become resistant to at least one first-line drug, often due to incorrect dosage or premature treatment termination. Drug-resistant cases require second-line drugs such as Fluoroquinolones and involve longer treatment durations.

Standard drug-susceptible TB treatment involves two phases. The initial phase uses four medications—Isoniazid, Rifampin, Pyrazinamide, and Ethambutol—administered orally once daily for eight weeks. The continuation phase then includes Isoniazid and Rifampin for four to seven months, totaling approximately six to nine months of treatment.

Directly Observed Therapy (DOT) is a strategy where a designated healthcare provider observes patients swallowing their TB medications to ensure adherence. This approach prevents nonadherence and reduces the risk of multidrug resistance. DOT can be administered in clinics, hospitals, or patients' homes, making it a flexible yet effective monitoring strategy.

Continuous patient monitoring is essential for evaluating TB treatment effectiveness. Monthly assessments include sputum culture testing to confirm treatment response, and laboratory tests measuring liver enzymes, creatinine, and blood urea nitrogen. These regular follow-ups help healthcare providers promptly address any side effects or complications and adjust treatment as needed.

Second-line drugs for drug-resistant TB include Fluoroquinolones such as levofloxacin and moxifloxacin, and aminoglycosides such as streptomycin, ethambutol, and cycloserine. These medications are used when first-line drugs fail to eradicate TB bacteria. Treatment with second-line drugs must be individualized and typically involves a longer duration of therapy than standard regimens.

TB patients in hospitals require droplet precautions with healthcare providers wearing gowns, gloves, N95 masks, and protective eyewear. Patients should be housed in negative pressure rooms or rooms equipped with HEPA filters. Proper nutrition, good hygiene, and correct cough etiquette are also essential for preventing disease transmission and supporting recovery.

Proper nutrition is essential for successful TB treatment. A well-rounded diet abundant in vitamins, minerals, and protein fortifies the immune system and facilitates recovery. Combined with infection control measures and nursing management and prevention strategies, adequate nutrition supports the body's ability to respond to treatment and recover from active TB disease.