Patient Initial Evaluation & Follow up

1. Patient Initial Evaluation & Follow up

2. Pretreatment screening and evaluation: • Initial evaluation serves to establish a baseline and may identify patients who are at increased risk for adverse effects or poor outcomes.

3. During treatment evaluation: • patients should be monitored closely for signs of improvement, side effects or signs of treatment failure. • The recurrence of TB symptoms after sputum conversion, for example, may be the first sign of treatment failure. • For children, normal growth rate should be resumed after a few months of successful treatment.

4. The most important objective evidence of improvement is conversion of the sputum smear and culture to negative. • chest radiograph may be unchanged or show only slight improvement, especially in re-treatment patients with chronic pulmonary lesions.

5. initial pretreatment clinical investigation includes: • A thorough medical history and physical examination. • Direct smear examination • DST for first and second line anti-TB drugs. • Liver functions: • Total serum Bilirubin • SGPT & SGOT • Total serum albumin, total serum protein and A/G ratio.

6. Serum Creatinine, blood urea, complete urine analysis with estimation of total urine protein content • Serum uric acid. • Fasting and PP blood sugar. • Serum Sodium and Potassium. • HIV • Pregnancy test. • Initial chest x-ray

7. Monitoring during DR-TB treatment

10. Monitoring of side effects should also include base line and check of: • Full blood count. • In highly risk patients (over 50 years, renal insufficiency, DM, HIV, underweight), creatinine should be evaluated every week or every other week for at least the first month of treatment.

11. Creatinine clearance may be needed for high risk group patients. • Audiometry or hearing evaluation. • Visual acuity and color vision evaluation. • If Serum potassium is low, check the Magnesium and Calcium levels

12. Special attention should be paid for: • Liver toxicity • Vestibular and hearing toxicity with injectable drugs • Psychiatric disorders with Cycloserine • Allergic reactions • Hematological changes .

13. Summary of important adverse reactions

14. Summary of important adverse reactions, (cont.)

15. Side effects, general considerations • All anti-tuberculosis drugs are associated with side effects. • Adverse effects are not a contraindication to appropriate treatment. • Poorly managed side effects may lead to non-adherence or inappropriate therapy. • Minor side effects are common during initial months of treatment. • Serious reactions are rare but require attention.

16. Side effects, general considerations, (cont.) • Community health workers and DOT enable close surveillance for adverse effects during ambulatory treatment besides, close communication with patient and family members. • Timely diagnosis and early management are crucial. • Changes to MDR-TB regimen are rarely indicated • Ambulatory management is usually adequate.

17. THANK YOU