Tb Dots Kupang 05

8/17/2019 Tb Dots Kupang 05

1/95

SoedarsonoSoedarsono

Bagian Penyakit Paru Bagian Penyakit Paru

FK Unair – RSU Dr. Soetomo FK Unair – RSU Dr. Soetomo

SurabayaSurabaya


2/95

TB di Dunia

Setiap hari 20.000 orang jatuh sakit TB

Setiap jam 833 orang sakit TB

Setiap menit 13 orang jatuh sakit TB

Setiap 5 detik satu orang jatuh sakit TB

Setiap hari 5.000 orang meninggal akibat TB

setiap jam 208

orang meninggal akibat TB

Setiap menit 3 orang meninggal

akibat TB Setiap 20 detik 1org meninggal akibat TB

Setiap detik satu orang

terinfeksi TB


3/95

TUBERCULOSIS – Still a threat

1/3 of the orld infe!ted

2"3 million deaths/#ear $iagnosis is slo

T% is long& !ompli!ated and to%i! 'esistan!e is rising

David Schlossberg, 2004


4/95

TB (re)alen!e*

+ost TB !ases are in ,ndia& -hina and ,ndonesia

10 000 to 99 999

100 000 to 999 999

1 000 000 or more

< 1 000

1 000 to 9 999

No Estimate

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the WorldHealth rgani!ation "on"erning the legal status of any "ountry# territory# "ity or area or of its authorities# or "on"erning the delimitation of its frontiers or

boundaries$ %otted lines on maps represent approximate border lines for whi"h there may not yet be full agreement$

& WH '00'


5/95

ighest TB in!iden!e rates

are found in fri!a and sia

'( to )9

(0 to 99

100 to '99

< 10

10 to ')

*00 or more

No Estimate

per 100 000 population

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the WorldHealth rgani!ation "on"erning the legal status of any "ountry# territory# "ity or area or of its authorities# or "on"erning the delimitation of its frontiers or

boundaries$ %otted lines on maps represent approximate border lines for whi"h there may not yet be full agreement$

& WH '00'


6/95

,s!haemi! heart disease,s!haemi! heart disease

-erebro)as!ular disease-erebro)as!ular disease

oer respirator# infe!tionoer respirator# infe!tion

$iarrhoeal disease$iarrhoeal disease

(erinatal disorders(erinatal disorders

-($-($

Tuber!ulosisTuber!ulosis

+easles+easles

'oad traffi! a!!idents'oad traffi! a!!idents

ung !an!er ung !an!er

thth

Stoma!h !an!er Stoma!h !an!er

,,

Sui!ideSui!ide

14401440

uture global mortalit#

Murray & Lopez: Lancet 1!

20202020


7/95

-ountr# 6o. of !ase ,n!iden rate

India

China

Indonesia

South Africa

Zimbabwe

Cambodia

Total 22 HBCs

1.820.!"

1.##$."#$

%81.8#$

2#.0!

80.$

$8.%!#

!.$$!.1!2

1$8

11

2$1

%%!

!28

%8%

1$$


8/95

Estimates of B Burden

Indonesia, 2004

,n!iden!e* 7 TB !ases* 590.000 ne !ases per #ear*

6: 6:; -S: / +,6


9/95

Potensial Penularan Penderita TB :Potensial Penularan Penderita TB :

+ Drajat penyakit / Drajat penyakit /bakteriologisbakteriologis

+ Drajat & frekuensi Drajat & frekuensi

batuk batuk + Kualitas & jumlah Kualitas & jumlah

sekrit jalan napas sekrit jalan napas

+ Pemberian obat anti Pemberian obat antiTB sebelumnyaTB sebelumnya

+ Karakteristik paparan Karakteristik paparan


10/95

Risk factors associated with developing TBRisk factors associated with developing TB

disease. Relative risk with respect to thedisease. Relative risk with respect to the

normal populationnormal population',SC -T' ':T,: ',SC

HIV INFECTION 50-100

JEJUNOCAECAL SHUNT 27-63

SOLID TUMOURS 1-36

SILICOSIS 8-34

HEAD AND NECK NEOPLASMS 16

HEMODYALISIS 10-15

HAEMOTOLOICAL NEOPLASMS 4-15

FI!ROTIC LESIONS 2-15

IMUNOSUPPRESSIVE DRUS 2-12

HAEMOPHILIA "ASTRECTOMY 5

LO# !ODY #EIHT 2-4

DIA!ETES MELLITUS 2-4

HEAVY SMOKIN 2-4

NORMAL POPULATION 1


11/95

I$%&'()*()+,(

P,()&$ T! D&,(,

.S/,

!TA P()+)%

.65

!TA N&,+)%

!),',$ P()+)%

.26

!),',$ N&,+)%

R,))( P(

.17


12/95


13/95

:%posure

Sub!lini!al

,nfe!tion

,nfe!tious

tuber!ulosis

6on"

,nfe!tious

tuber!ulosis

$eath

'isk

fa!tors'isk

fa!tors

'isk

fa!tors

'isk

fa!tors

(athogeneti!all#"based model of the epidemiolog#

of tuber!ulosis

"#$%LD, 2002 : "ntervention or %' (ontrol and )li*ination+


14/95

:%posure Sub!lini!al

infe!tion

,nfe!tioustuber!ulosis

6on",nfe!tious

tuber!ulosis

$eath

(roph#la!ti!

treatment

(re)enti)e

therap#

B-D

)a!!ination

T,$()(()$ !hemotherap#

$o!tors dela#

patients dela#

Model o interventions based on the

epide*iology o tuberculosis


15/95

PENYEBAB

TB YANGTINGGI DI

DUNIA

KETIDAK PATUHAN

THD PRGRA!

DIAGN"I" #

PENGBATAN YG

TIDAK ADEKUAT

HI$

ENDE!IK

RA%AT &A'AN DENGAN"E'( AD!INI"TRATI$E THERAPY

)"AT*

!DR+TB

Int J Tuberc Lung Dis 1998 ; 9 : 969-703


16/95

in Persahabatan Hospital (Category I)/Syafrial

@ear

2000"2001 2000"2001D E 50 "A E 50

C*& 33 .66 23 .46

C&+& +&,+&$+ 1 .2 8 .16D *+ 8 .16 14 .28

M9& 1 .2 3 .6

D)& 1 .2 0

D* )$*:& H&,+)+)( 2 .4 2 .4

T&,+&$+ %,)*& 2 .4 0

R&()(+,$+ OAT 2 .4 0

A&): 0 0


17/95

F$TSGST-ured H >14&5? 4 >&28?

-omplete 82 >3H&H5? H0 >35&29?ailed H >1&98? H >0&3?

$rop out 88 >39&4? 90 >50&29?

+o)e 1 >&1H? 9 >5&03?

$ied 0 0

thers 0 25 >1&88?

TT 238 1333

Persahabatan HospitalRetrospective July 1 !

June "##1

Persahabatan HospitalRetrospective July 1 !

June "##1


18/95

PENYEBAB GAGA' PENGBATAN TB

PA'ING "ERING )DI!ANAPUN* ADA'AH


19/95

INTI PENGBATANINTI PENGBATAN

)),RE !ANAGE!ENT ,RE !ANAGE!ENT **TB ADA'AH -TB ADA'AH -


20/95


21/95

,'INI,A' APPRA,H

Basic scienceof !"

t#ber$#losis

$ppropriate

regimen

Basic science ofanti tuberculosis

drug

%&'($)*'T$+ PR,'-,P+*,' T&B*R-&+/,/

-'TR+

Treatmentcompletion

(T (T

PUB'I, HEA' H

APPRA,H


22/95

PENGBA AN DENGAN " RA EGI D "

ENGBA AN DENGAN " RA EGI D "

(DOTS : Directy Obser!ed T"era#y$ S"ort(DOTS : Directy Obser!ed T"era#y$ S"ort%ourse&%ourse&

Pusatkan (Pusatkan ( D'R%T D'R%T attentionattention) pd identifkasi BTA) pd identifkasi BTA

Observasi (Observasi (OBSR)OBSR) ) langsung px minum) langsung px minum

obatnyaobatnya

Pengobatan (Pengobatan (TR*T+,TTR*T+,T ), dg regimen obat :), dg regimen obat :

OAT angka pendek (OAT angka pendek (S-ORT%OURSS-ORT%OURS ), melalui), melalui

pengelola!an, distribusi " penyediaan obat ygpengelola!an, distribusi " penyediaan obat yg

baik baik


23/95

KOMITMEN(POLITIK)

DIAGNOSIS TB

UTAMA MELALUITEMUAN BTA

(MIKROSKOPIS)

PENGOBATAN

JANGKA PENDEK

& PENGAWASAN

LANGSUNG

PENYEDIAAN

OBAT

PENCATATAN &

PELAPORAN YG

BAKU

Strategi

DOTS

1

2

3

!


24/95

"O#IT#E$ %DO"TER&"O#IT#E$ %DO"TER&

DI'($OSIS UT'#' TB :

IDE$TI)I"'SI "U#'$ %BT'& *I'

+'PUS'$ D'+'" L'$(SU$(

DI'($OSIS UT'#' TB :IDE$TI)I"'SI "U#'$ %BT'& *I'

+'PUS'$ D'+'" L'$(SU$(

"ETERSEDI''$ OB'T"ETERSEDI''$ OB'T

PE$(OB'T'$ ,'$("' PE$DE" -

PE$('.'S'$ L'$(SU$(

PE$(OB'T'$ ,'$("' PE$DE" -

PE$('.'S'$ L'$(SU$(

PE$C'T'T'$ - PEL'POR'$

/'$( B'"U

PE$C'T'T'$ - PEL'POR'$

/'$( B'"U

1

2

3

4

!


25/95

N R'

" RA EGIE"

. BG

.

PRE$EN I$E

HERAPY

N R'

" RA EGIE

"

. D "

"URE

DE" INA IN

RU E

N R'

" RA EGIE"

. I"'A IN

. U$ 'IGH


26/95

Total kasus baru #ang BT positif

(enderita #ang sadar tentang pen#akitn#a

(enderita #ang pun#a akses ke pala#anan kesehatan

(ta #ang mengunjungi

(uskesmas

(ta #ang kunjungi

'S/ B(H(ta di Se!tor

Sasta

(ta #g diperiksa

Iumlah

terdiagnosa

$iobati

sembuh

J J

+&,

PIOT MODELPIOT MODEL

ngka Cesembuhan #ang terlapor ngka Cesembuhan #ang terlapor

-$' #ang terlapor -$' #ang terlapor

,nsidensi #ang n#ata,nsidensi #ang n#ata


27/95

'umah

Sakit/B(H

(uskesmas

#P$


28/95

Histopathol o%gi$al test

pi'emiologi $ approa$h

Imagingte$hni#e

!i$robiologi$al test

Clini$alassesme

nt

(iagnosis(iagnosisof TBof TB

0conventional0conventional


29/95

DIAGN"I" B

$iagnosis (ST, > OLD STANDARD ? *

ditemukan kuman +. tb biakan >kultur? K

tes identifikasi

$alam strategi doAs * identifikasi kuman

+.tb $,#HY; ?


30/95

D),$(+): + D),$(+): + #ang terbaik untuk TB#ang terbaik untuk TB

se#og#an#a memenuhi 5 kriteria *se#og#an#a memenuhi 5 kriteria *

1.1. Mudah dikerjakanMudah dikerjakan

2.2. Cepat Cepat 3.3. MurahMurah

4.4. Spesiftas tinggiSpesiftas tinggi

5.5. Mampu menilai daya tular Mampu menilai daya tular


31/95

%inimal &

OAT pada'ase intensi'

!arus

diberikan

'nde/res#onse

t"era#eutic

yg paling

Potensialmenula

r

$eleksistrain

mutanresistensit!d OAT

tinggi

!TA ()+)%


32/95

JUMLAH

SAMPEL

PORSENTASE !TA

POSITIF POSITIF DENAN


33/95

(:'B6$,6D6 S, (:+:',CS6

+,C'SC(,S $6 C)'('>,$?,+,*

'*+*

1 sesaat

pagi

99

9

40

43 43

2 2 % sesaat

1 % sesaat dan 1 % pagi

2 % pagi

9

81

83

4H

49

4 4

3 2 % sesaat dan 1 % pagi

1 % sesaat dan 2 % pagi

8H

8H

48

44 44

H 2 % sesaat dan 2 % pagi 85 44 100

Tuber"le#19(9# )0 1((1,'


34/95

Per/em0an1an dia1nosis 2a0oratoris TB

Bakteriologiseluler :

Biakan 0identi1kasi

radiometr ik(B*%T%&

Bakteriologimolekuler

:

U2i P%R

U2i 3%R

$erologi :

U2i 3'S*TB$u2i +ycodot$u2i P*P TB$u2i TBDot(Dot'*&

U2iimunokromatogr

a1 (U2i '%T&


35/95

R ( S U +

(

D ' * 4 , O S T

' K

3 * B

O R * T O R '

S .

T B

$putum BTA :* ui

saring terdepan,mura!, praktis,sens

* pemantauan!asil tx

Biakan da!ak :*

$TA#A-# .%A$

* ui resistensi*

pemantauan !asil

tx

/i P0- 1 20- :* unt3

kasus bermasala!* ui

resistensi 4epat

/i $erologi :*

pili!an utama untuk P*U%'B*%'33*R5

TB


36/95

'ole of -hest L"ra#'ole of -hest L"ra#

N :/&(+ @-, ,++&$ )( ,=(*+& +):, %N :/&(+ @-, ,++&$ )( ,=(*+& +):, %

T!T!

10-15 % :*+*&-()+)9& T! ,+)&$+( $+10-15 % :*+*&-()+)9& T! ,+)&$+( $+

),$(& = @-, ),$(& = @-, 40 ,+)&$+( ),$(& ,( /,9)$ T! $ +/&40 ,+)&$+( ),$(& ,( /,9)$ T! $ +/&

=,()( % @-, ALONE $+ /,9& ,:+)9& T!=,()( % @-, ALONE $+ /,9& ,:+)9& T!

L"ra# 6: is unreliable for diagnosingL"ra# 6: is unreliable for diagnosing

and monitoring treatment of TB and monitoring treatment of TB


37/95

Inter+o0ser3er

a1reement -

405 675


38/95

bserver error : under-reading and over-reading o

chest radiographs

:%perien!e 6umber of

readers

?

>a? 1"H #ears 3 28&0 18&0

5"4 #ears 3 14&2 14&0

M 10 #ears 88 1&9 1&0

O

>b? 1"500 films annuall# H3 22&H 1&5

5.000"20.000 films

annuall#

H8 2H&0 18&0

M 20.000 filmsannuall#

H1 15&2 15&5

)erage of all readers 21&8 14&5

N,',*, K &+ ,B 1"70

C*9&( % )(,&&&$+ )$ ,),/): ,$


39/95

0

(

10

1(

'0

( 10 1( '0 '( *0 *(0

'(

*0

*(

L"ra# e%amination

1 2avity present

3putumsmear examination

' ne or more ba"illi on slide 4

* Three or more ba"illi on slide 4

) Eight or more ba"illi on slide 4

(roportion >? of dis!ordant F #es F ansers

( r o p o r t i o n > B ? o f d i s !

o r d a n t F # e s F a n s e r s

C*9&( % )(,&&&$+ )$ ,),/): ,$

(*+*-(&, &,)$,+)$(1

2

3

H


40/95

$isagreement beteen reading of !hest$isagreement beteen reading of !hest

films of 400 patientsfilms of 400 patients

'eaders'eaders ,nter"indi)idual,nter"indi)idualdisagreement >?disagreement >?

,ntra"indi)idual,ntra"indi)idualdisagreement >?disagreement >?

5a65a6 To groups of e%pertsTo groups of e%perts

>Three radiologists K three>Three radiologists K three

!hest spe!ialists?!hest spe!ialists?Droup Droup 2424 1414

Droup BDroup B 22 2H2H

5b65b6 To e%pert readers >readingTo e%pert readers >reading

the same material?the same material?

3030 2121

$*erican .ournal o roentegenology and /adiu* therapeutic nuclear *edicine, 1+


41/95

H,+)-/,+) &$),$()( T! ,* /,$,

=&,(,',$ %+ ,, (,,


42/95

R&(*+( % ,),/): &,)$,+)$ :,& )+/ +/(& %

(*+* (&, ):(: .S ,$ (*+* :*+*& .C )$

*+,+)&$+( )+/ :)$):, ()$( (*&(+)9& % +*=&:*()(

-lassifi!ation b#radiograph#

6o. ofpatients

'esult of sputum e%amination

S A S " S A S "

- A - A - " - "

Tuber!ulosis >TB? 22 122 20 H 81

ther abnormal

shados >non"TB?

30H 8 H 1 241

6ormal 1948 " 8 10 1980

Total 2224 130 32 15 2052

The Tuber"ulosis 7sso"iation of 8ndia 8:7T;%# 19.(


43/95

(orrelation o the yield o radiographic ea*ination

and sputu* culture in patients ith clinical signs

suggestive o tuberculosis

Radio1ra89:

,u2ture

ositive Negative Total

ositive 1)' /( ''.

Negative '0 19/' '00'

Total '''9 '0,. '''9


44/95

ati"hati

dengan

informasidari

pemba!aan

foto toraks

N


45/95


46/95

TB +iliar#


47/95


48/95


49/95


50/95


51/95


52/95


53/95

T*+C,I-T*+C,I-

TSTI-.TSTI-.• 2urang bernilai

sebagai saranadiagnosis3khususnya dinegara denganprevalens TB

tinggi

• Pada anak 4 5th

terutama dinegara

dg prevalens TB

rendah amat

6ambaran Histopatologi


54/95

The lesion is $ompose' of ro#ghly of lympho$ytes ma$rophages an' epithelioi' $ells with small area of $entral $aseation ne$rosis

a gran#loma typi$al of T*

6ambaran HistopatologiTB

When to 2onsider Treatment 8nitiation


55/95

When to 2onsider Treatment 8nitiation

first medi"al "onsultation

Wh t 2 id T t t 8 iti ti d


56/95

T&,$+*$ ,, %,())+) ,$ SDM ,$ ,, G =), +&=,+,( =)(, ,$(*$

+&,+&$+ .NTPB =), &*$')$',$ &,=),$ (&()&$ .)$9,()9&B )(

=$'(')B (&=&* +&,+&$+ )*,)

When to 2onsider Treatment 8nitiation se"ond

medi"al "onsultation 5 if "ontinues symptoms6


57/95

Prin;i82es of T9era8:

Combination of drugs to avoidselection of drug resistance

Prolonged treatment to ensure thatall bacterial destroyed

Shortest regimen : 6 months

(need PZA in 1st 2)

DOT – core management


58/95

Anti+tu0er;u2osis

9era8:

(irst 'ine Dru1s

Isonia


59/95

&an1an sa2a9 8erse8si?@-&an1an sa2a9 8erse8si?@-

obat lini =e duaobat lini =e dua tida/ 2e0i9 0ai/tida/ 2e0i9 0ai/ dari obat lini pertamadari obat lini pertama

(UNDA!ENTA' IN TB TREAT!ENTTHE R'E ( PR$IDER


60/95

RE"PN"IBI'I

E"PN"IBI'I

Y

APPRA,H

PPRA,H

Pres;riin1

a88ro8riate re1imen #

ensurin1

;om8etion of t9era8:

Dire;t ser3e

9era8: )D *

(UNDA!ENTA' IN TB TREAT!ENT THE R'E ( PR$IDER


61/95

BA,TERIA'

PPU'ATIN A,TI$ITIE"

ANTI+TB DRUG"

T9e BA"I" of

ANTI+TB DRUG"REGI!EN"

RE"I"TAN,EPATTERN (A'' # RI"E

PHEN!ENA

'AG PHA"E

"PE,IA' BA,TERIA' PPU'ATIN" HYPTHE"I"


62/95

"PE,IA' BA,TERIA' PPU'ATIN" HYPTHE"I"

+I(+

LO.

S0eed o

aterial

gro4th

P*,+)$ A G

- E&,$+ %,- 10 7 -10 "

- :,9)+, ,(

- &+,:&*,

- %,)*&

+&,+&$+

P*,+)$ ! G

- S,):

- 10 3-10 5

- () :,(&*

- &,(&

P*,+)$ C G

- ,:) )$/)=)+)$

- 10 3-10 5

- )$+,:&*,

- &,(&

P*,+)$ D G

- L,:' &+,=):

,:+)9)+- $ :*&

- &,(& )$

(&9&& )*$&%>

"PEIA' BA ERIA' PPU'A IN"


63/95

HYP HE"I" AND A IN (

HE "PE"I(I DRUG"

+I(+'

Continuousgro4th

D

Dor5ant%no ure&

LO.

S0eed o

aterialgro4th C B

'id S0urts o

inhiition 5etaolis5

I$+% Ri6 Stre0&

P7' Ri

A = rapidl !r"#i$! %a'ria illd *ai$l IN+ , B = %ailli "$l *'a%"li-i$! i$

.p/r'. illd *ai$l % Ri0 , C = %ailli i$1i%i'd % a$ aid $2ir"$*$' illd

*ai$l % P3A , D = d"r*a$' %ailli

?


64/95

10

0 * , 9 1' 1( 1/

I($),)-(*(:&+)=&

,$)((

I($),)-&()(+,$+

,$)((

;eeks of treatmentS+,+ % +&,+&$+

.)($),) ,$&

0

101

10'

10*

10)

10(

10,

10.

10/

Smear O

-ulture O

Smear O

-ulture A

Smear A

-ulture A

6 u m b e r

o f b a ! i l l i p e r m i l o

f s p u t u m >

l o g a r i

t h m i ! s ! a l e ?

: l b t i id l


65/95

R&,+)9& ,:+)9)+

% ,$+)-T!&):,+)$(

:arl# ba!teri!idal

a!ti)it#

(re)enting drug resistan!e

SteriliPing

a!ti)it#


66/95


67/95

'actericidal activity o isoniazid co*pared to a our drug

co*bination therapy over the irst to ee3s o treat*ent


68/95

S:/&,+): &(&$+,+)$ &$(+,+)$ +/&

&:/,$)( % +&,+&$+ %,)*& ,$ )(&,(& &,(&>

6umber of

organisms

:%tra!ellular ba!illi

,ntra!ellular ba!illi

ailure

'elapse

$uration of !hemotherap#


69/95

A=))+ % ,$ ,$+)-+*=&:*()( * + &9&$+ ,( ,

:,$)$ * &&&$:& % )($),) &()(+,$:&

T!e development and spread o' drug* and

.


70/95

T!e development and spread o' drug* andmultidrug*resistant tuber4ulosis3 ( 6-O 78999.

*ntitubercuosis drug resistance in t"e ;ord&

562# %3 tuber4ulosisstrain

(4ontains a small number 789; o' naturallydrug*resistant organisms arising

t!roug! spontaneous mutations)

562# %3 tuber4ulosisstrain

(4ontains a small number 789; o' naturallydrug*resistant organisms arising

t!roug! spontaneous mutations)

A0


71/95

71#8 rganisms inTB -avity

1 resistant R,%1## resistant ,'H1## resistant /trep1## resistant *)B

# resistant ,'H9Rif # resistant ,'H9Rif9*)B

%or 'ew -ase 'ever Treated

umber o' ba4illi re?uired 'or t!eumber o' ba4illi re?uired 'or t!e


72/95

??

appearan4e o' a mutant resistant toappearan4e o' a mutant resistant to

di@erent drugsdi@erent drugs I($),) .H 1 10 5 -10 6 =,:))

R)%,):)$ .R 1 10 7 -10 8 =,:))

S+&+:)$ .S 1 10 5 -10 6 =,:))

E+/,=*+ .E 1 10 5 -10 6 =,:))

P,)$,)& .


73/95

10 '0 *0 )0 (0 ,0 .00 /0 90 100

9'-

.(-

,/-

,)-

)(-

*(-

Total !ohort >n E 4?

ar ad)an!ed&

!a)itar# >n E 520?

+oderatel# ad)an!ed&

-a)itar# >n E131?

ar ad)an!ed&

6on!a)itar# >n E 88?

+oderatel# ad)an!ed&

6on!a)itar# >n E15?

+inimal disease >n E 81?

er"ent


74/95

RECOMMENDED TREATMENT REGIMENS FOR EACH DIAGNOSTIC CATEGORYRECOMMENDED TREATMENT REGIMENS FOR EACH DIAGNOSTIC CATEGORY(WHO 2003)(WHO 2003)

TB T':T+:6T ':D,+:6S


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TB$,D6ST,-

-T:D'@ TB (T,:6TS

TB T':T+:6T ':D,+:6S

,6,T, (S:>$,@ ' 3 T,+:S

;::C@?a

-6T,6$,@ ' 3 T,+:S

;::C@?a

I

e s*ear-positive patients5e s*ear-negative 6%' 7etensive parenchy*alinvolve*ent5Severe conco*itant 8"9disease or severe or*s o)6%'

2 HR


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0 1 ' * ) ( ,

:ffe!t of adding a fourth drug >ethambutol? during the first to

months to a rifampi!in throughout regimen on !ulture !on)ersion.

INTI PENGBATAN


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),RE !ANAGE!ENT *

TB ADA'AH -

100


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'0

)0

,0

/0

' ) , / 10 1'0

100

0

ome

Sanatorium

$uration of treatment >months?

- u l t u r e n

e g a t i ) e > B ?

A::&+,=& +/) )$& &)&$( %


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+/& +&,+&$+ % MDR +*=&:*()(


80/95

TOP MANAGEMENTTOP MANAGEMENT

PR),T'O,

DOTS STR*T45

%#-*TB

A, ,$ +&=,)' ,,


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D "

D " 8us

&$,+,,'(,$,,$ MDR-T! ;

Terapi

+$'"TB

(en!egahan

+$'"TB


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.

a/terio2o1i/ a/terio2o1i/

.

radio2o1is radio2o1is

.

/2inis /2inis

.

efe/ sam8in1 efe/ sam8in1

.

/eteraturan/eteraturanminum oat minum oat

!NI RING = E$A'UA"I

NI RING = E$A'UA"I

"E'A!A PENGBA AN

E'A!A PENGBA AN


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DEMAM BIASANYA

MEMBAIK DLM 456 MG

BATUK

4 BULAN

PERBAIKAN

RONTGENOLOGIS

7 BULAN

CON8ERSION SPUTUM INDE9 T9

RESPONS

PLG AKURAT

@$ 8 $A di#engaru"i ?aktor8 eksterna (komorbid&

RE"PN"

TERAPITB

C$9&()$ )$ (&, ,$ :*+*& % )$)+),


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(0

,0

.0

/0

90

100

) / 1' 1, '0 ') '/ *' *,

52

40

82

1

49

43

8H

91

44494543

48 44 44 44 44

!ulture

smear

;eeks till !on)ersion

( e r ! e

n t a g e n e g a t i ) e

> ! u m u l a t i ) e ?

(&,-()+)9& *$, +*=&:*()(

I$+&&+,+)$ % +/& &(*+( % (*+* &,)$,+)$


85/95

= (&, ,$ :*+*& *)$ +*=&:*()( +&,+&$+

+6T S+:' -ulture S+:' -ulture S+:' -ulture S+:' -ulture

0 AA AAA AA AAA AA AAA AA AAA

1 AA A AA AA AA AAA AA AAA

2 0 0 A 0 AA AA AA AA

3 0 0 A 0 0 A AA AA

H 0 0 0 0 0 A AA AAA

5 0 0 0 0 AA A AAA AAA

9 0 0 0 0 AA AA AAA AAA

':S("6S:


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!NITRING E(EK "A!PING # PENANGANANNYA

T*T$P

+$'J&T2$'$T

P*'$'6$'$'

/TP $T: /*)*'T$R$

: /*T*R&/';$

),'R

J*',/ *%*2

/$)P,'6 <

)$JR

T.T/AOAT >A=B.-TA==/=

A5AB%.>.BABA.C. $A%P6=T.-$.B/T

6-O (@CC&. TB. * %inica +anua ?or Sout"

ast *sia

S,$:"::-T $'


87/95

':S(6S,B:

MINOR G

− yeri sendi

− /asa panas di 3a3i

− $nore3sia, *ual,*untah

6irazina*id

"soniazid

/ia*pisin

$spirin

6irido3sin 100*g7hr

Minu* bersa*a *a3anan

MAJOR G

− ?atal, rea3si 3ulit

− %uli, telinga berdenging

− @aundice

− ?angguan visus

− 6urpura, syo3, gagalgin.al a3ut

Strepto*isin

/ia*pisin atauisoniazid

Strepto*isin

"soniazid,ria*pisin,

pirazina*id

)ta*butol

/ia*pisin

Stop seterusnya

Stop, desensitisasi, beri3anlagi

Stop seterusnya

Stop sa*pai .aundice hilang

Stop seterusnya

Stop seterusnya


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PENA A AN

• B'"U - CO+ORT %)OR# 8 TB&

• DE$('$ )OR#82 TSB D'P'T #E$IL'I

+'SIL8+'SIL :

PE$(OB'T'$ TI'P "'SUS

8 SEMBU+

5 PENGOBAT:LENGKAP 5

DE;AULT 5

GAGAL 5 RELAPS


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Pengisianform T*%01

PPDS yangse'ang

menga2ar3an isiform T* 'an$ara mengisinya

pa'a


90/95


91/95

=2OBA2 6%P2.%.TAT6OOC #OT$

TD. #6$.A$.B/-#.

- +DRTB -')

6EOUT 4OOD

'+P3+,T*T'O,OF DOTS

T- D'S*S

BURD,(+DRTB$ T%&

K3B'-*,


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RU!AH "AKI " RA EGI

D "

D'*4,OS'S *KUR*T ( SD+$ F*S'3'T*S& PUS*T RUUK*,

*,4K*U*, P3*5*,*, 3U*SS*R*,* D'K3*T 5*,4 'D*3

6'3*5*- KR*T,*4* 3*P*,4*,

K3B'-*,

KKUR*,4*, (G&

Be0era8a 8i2i9an untu/


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ptions $iagnosis-lassi"

fi!ation

Start

TreatmentTreatment

-lini!al

5ollo up'eporting

12

3

H

in .ospital

in .ealth -enter

Be0era8a 8i2i9an untu/

8e2a:anan 8enderita TB di R"


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!&*,$ +&*(>


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Tb Dots Kupang 05

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