REFLEKSI KASUS

REFLEKSI KASUSDiah Saraswati13223Indentitas Nama: Tn. SJenis kelamin: laki-lakiUsia: 39 tahunAlamat: Sukaraja Kulon, BanyumasTanggal masuk: 24 Januari 2014Keluhan UtamaRiwayat Penyakit Sekarang

Pemeriksaan FisikParu

KananKiriInspeksi

Simetris (+), ketertinggalan gerak (-), retraksi (-), penggunaan otot bantu nafas (+)Palpasi

Pengembangan dada simetris, pelebaran sela iga (-), nyeri tekan (-), fremitus taktil normal

Pengembangan dada simetris, pelebaran sela iga (-), nyeri tekan (-), fremitus taktil menurun

Perkusi Sonor (+)Redup (+)Auskultasi

Vesikuler (+) normal, RBB (-), wheezing (-)

Vesikuler (+) menurun , RBB (+), wheezing (-)

Pemeriksaan PenunjangAL : 11.800AE : 5.38 x 10^6Hb : 14.5 g/dlHct : 40.7%AT : 494.000Neu : 9.17Lymp : 1.57Mono : 0.979Eo : 0.035Baso : 0.073Darah RutinRontgen ThoraxTerdapat perselubungan semiopak inhomogen pada kedua apeks paru disertai adanya kavitas di paru sinistraTerdapat adanya gambaran semiopak kasar di sisi lateral paruTerdapat gambaran opak homogen di paru sinistra, Sudut costophrenicus sinistra tidak terlihat, sudut costophrenicus dextra lancipCTR tidak dapat diukurSistema tulang tervisualisasi intak

Kesan : TB Paru dengan efusi pleura sinistra

Pengelompokan OAT

Sifat OAT

Dosis OAT Kombipak

Pengobatan Kasus Khusus

Treatment of TBKategoriPasien TBRegimen Terapi TBFase inisialFase lanjutIBTA positip, BTA negativ lesi luas, HIV positif, ekstra paru berat.2 HRZE

optional2HRZEOptional2 (HRZE) 34 HR4 (HR)3optional6 HEoptional4 (HR)3IIIBTA negative, ekstra paru tidak berat2 HRZE

optional2 HRZEOptional2 (HRZE)4 HR4 (HR)3optional6 HEoptional4 (HR)3KategoriPasien TBRegimen Terapi TBFase inisialFase lanjutIIRelap, Terapi setelah Default2 HRZES/IHRZEoptional2(HRZES)3 / 1(HRZE)35 HRE5 (HR)3IIGagal Terapi Kategori I, setting: -TB MDR rendahTidak ada fasilitas kultur MDR2HRZE/1 HRZEOptional2 (HRZES)3/1(HRZE)5 HRE5 (HRE)3IIGagal Terapi Kategori I, setting: -TB MDR tinggitersedia obat second lineObat diberikan secara individual berdasarkan hasil sensitivitas test dengan obat second lineIVKronik, suspect MDRObat diberikan secara individual berdasarkan hasil sensitivitas test dengan obat second line.(WHO, 2004)

TB Treatment CategoryTB patientsAlternative TB Treatment RegimensInitial phase (daily or 3 times/week)Continuation phaseINew smear-positive PTB;New smear-negative PTB with extensive parenchymal involvement;New cases of severe forms of extra-pulmonary TB2 EHRZ (SHRZ)2 (EHRZ (SHRZ)

2 EHRZ (SHRZ)6 HE4 HR

4 H3R3IISputum smear-positive;Relaps;Treatment failure;Treatment after interruption.2 SHRZE / 1 HRZE2 SHRZE / 1 HRZE

5 H3R3E35 HREIIINew smear-negative PTB (other than in category I) new less severe forms of extrapulmonary TB2 HRZ2 HRZ2 HRZ6 HE4 HR4 H3R3IVChronic case (still sputum-positive after supervised retreatment)Not application(Refer to WHO guidelines for use of second-line drugs in specialized centres)Possible Alternative Treatment Regimens for EachTreatment Category (WHO Guidelines)Essential Anti-TB Drug (abbreviation)Mg/dayAdult 70 kg bodyweightChild 25 kg bodyweightIsoniazid (H)Rifampicin Pyrazinamide (Z)Streptomycin (S)Ethambutol (E)Thioacetazone (T)3507001750-1050-125250625-375-Daily DosageEssential Anti-TB Drug (abbreviation)Recommended dose (mg/kg)Daily Intermittent 3 times/week2 times/weekIsoniazid (H)Rifampicin Pyrazinamide (Z)Streptomycin (S)Ethambutol (E)Thioacetazone (T)5 (4-6010 (8-12)25 (20-30)15 (12-18)15 (15-20)2.510 (8-12)10 (8-12)35 (30-40)15 (12-18)30 (25-35)15 (13-17)10 (8-12)50 (40-60)15 (12-18)45 (40-50)Not applicableStandardised Treatment Regimens by WHO (The essential anti-TB drugs)< 33 Kg33-35 Kg51-70 Kg>70 KgIsoniazid (H)Rifampicin (R)Etambutol (E)Pyrazinamid (Z)Streptomycin (S)4-6 mg/Kg10-20 mg/Kg25 mg/Kg30-40 mg/Kg15-20 mg/Kg200-300 mg450-600 mg800-1200 mg1000-1750 mg500-750 mg300 mg600 mg1200-1600 mg1750-2000 mg1000 mg300 mg600 mg1600-2000 mg2000-2500 mg1000 mgTabel 4. Rekomendasi dosis harian OAT lini pertamaTerima Kasih