BOF: 10
A 55-year-old male comes for his follow up appointment to
the respiratory clinic. He has been diagnosed as having pulmonary tuberculosis
and has been discharged from hospital 2 weeks prior to clinic attendance on a
regime that consists of rifampicin, isoniazid, ethambutol, pyrazinamide and
pyridoxine. He is a homeless alcoholic who has been housed in a hostel.
He says he does not feel well, no appetite, he is losing
weight and has a productive cough. His urine is clear and not discoloured.
On examination he looked unwell, had lost weight and
examination of the respiratory system revealed fine crepitations in both upper
zones.
The chest x-ray shows shadowing in the upper lobes that
are more extensive than the changes seen whilst he was an inpatient.
In this patient which one of the following would be the
best option to follow:
a)
Take repeat samples of sputum for culture and sensitivity and adjust
treatment according to the sensitivities
b)
Add streptomycin to his treatment regime
c)
Start him on steroids
d)
Give him treatment as directly observed therapy (DOT)
e)
Add ciprofloxacin
Answer: d)
The patient being homeless and alcoholic may not be
taking his treatment. The fact that his urine is not discoloured would surest
that he has not taken treatment as rifampicin usually causes an orange
discolouration of the urine.
The best way of ensuring compliance would be the use of
DOT
Revision Tip
Revise tuberculosis KEYS to SUCCESS in Medicine
pages
551-553
