Clinical meaning
TB treatment requires multiple medications taken for an extended period (6-9 months minimum) to kill actively replicating bacteria AND dormant bacilli within granulomas. The standard regimen is RIPE therapy: Rifampin, Isoniazid, Pyrazinamide, and Ethambutol for the first 2 months (intensive phase), followed by Rifampin and Isoniazid for 4 months (continuation phase). Treatment failure from non-adherence leads to drug-resistant TB, which is much harder to treat.
Exam relevance
Risk factors: - Non-adherence to medication regimen (most important modifiable risk factor) - Adverse drug reactions causing discontinuation - Substance abuse - Homelessness - Mental health disorders - Language or cultural barriers - Lack of social support
Diagnostics: - Monitor for medication side effects at each visit - Monitor weight monthly - Report signs of hepatotoxicity (jaundice, dark urine, RUQ pain, nausea) - Report visual changes (ethambutol toxicity) - Report numbness or tingling in extremities (INH neuropathy) - Collect follow-up sputum specimens as ordered