MDR TB CARE PLAN

Perform audiogram/vestibular screen. Continue monthly as long as aminoglycoside/capreomycin is given.

Perform vision screen. Continue as long as ethambutol, rifabutin, linezolid and clofazamine is given.

Assess and address substance abuse/psychosocial factors influencing compliance and education needs/completion of contact evaluation with health department.

Check CXR-PA/Lat, compare to old films. Request and review old records of the patient. Creat a dugo-o-gram, and review prior lab of CBC, BUN, Cr, LFTs, 24 hr Cr CI (repeat clearance if decreased and adjust medications such as aminoglycosides, apreomycin, ethambutol, PZA, levofloxacin and cycloserine), Ca#, Mg#, HB, HCV, glucose. Check baseline TSH, Review prior sputum results. Repeat sputum. Review susceptibility of patient and request extended susceptibility dest (for patients at high risk for MDR-TB request rapid molecular assay for drug resistance [consultation required]). Provide infection control isolation. Check the patients baseline weight and height.

In the initiation of treatment consider a CT scan and alternate views. Provide a physician assessment and update drugo-o-gram. Draw sputum in the morning for 3 days, smear and culture. Continue infection control isolation until culture is negative 3 times througout threatment. Give Aminoglycoside and or Capreomycin IV (IM) 5 days per week. 4 to 6 oral drugs and initiate DOT and educate the patient. Give Pyridoxine 100mg. Calculate Body Mass Index and give a nutritional assessment.

Month 1

Provide a physician assessment for 1 to 2 weeks. Update drug-o-gram on a monthly basis througout treatment. Check CBC, BUN, Creat, LFTs, K, Ca, Mg at least once a month throughout treatment. If positive CD4, viral load. Take sputum in the morning 3 times a day, smear and culture. Peak/trough drug level, peak drug levels 2 hours post does (PAS 6hr) and educate the patient as needed. Give pyridoxine 100mg, as long as ethionomide, linezolid, or cycloserin given (do this throughout the treatment). Weigh the patient weekly.

Month 2

Provide a physician assessment every 1 to 2 weeks. If positive CD4, evaluate for treatment. Take sputum culture every month throughout treatment. Repeat susceptibility if sputum is positive. Peak/trough drug level. Weight monthly for the rest of the treatment.

Month 3

Consider doing a chest x-ray. Perform a physician assessment every month for the rest of treatment. Give TSH for 3 months if on PAS and or Ethionamide. If elevated then give Levothyroxine treatment, check this monthly for the rest of treatment. Repeat susceptibility every month if culture is positive, check this every month for the rest of treatment. Peak drug levels 2 hrs post dose (PAS 6 hr).

Month 4

Peak/trough drug level.

Month 6

Perform a chest x-ray and change Peak/trough drug to 3 times a week after 4 to 6 months if culture is negative.

Month 9

Peak/trough drug D/C after culture is negative for 6 to 12 months.

Month 12

Perform a chest x-ray and consider a CT scan. Peak drug levels 2 hrs post dose (PAS 6 hr)

Month 18

Perform a chest x-ray

Month 24

Perform chest x-ray and consider a CT scan.

Produced by Heartland National TB Center.
Consultation to healthcare providers at 1-800-TEX-LUNG, www.HeartlandNTBC.org
This producted produced with funds awarded by the Centers for Disease Control & Prevention (CDC).