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A 43-year-old man presents to the clinic with complaints of fever, night sweats, anorexia, cough, and chest pain. The chest x-ray reveals infiltrates in both the lower and upper lobes, with possible cavitations in the apices. A presumptive diagnosis of tuberculosis is made on the basis of finding acid-fast bacilli (AFB) on microscopic examination of sputum. The patient is started initially on isoniazid, rifampin, pyrazinamide, and ethambutol. What is the best way to monitor this patient?
(A) Sputum acid-fast stains every month for 6 months
(B) Sputum cultures every month until cultures become negative
© Serial chest x-rays
(D) Blood testing for drug toxicity
(E) Observe for clinical deterioration
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didnt we just answer this.... its A
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Patients who have pulmonary tuberculosis should have sputum cultured every month until cultures become negative. Eighty percent of patients usually have negative sputum cultures by the end of the second month of treatment. If cultures remain positive after three months, the isolate should be retested for susceptibility, and possible changes should be made in the drug regimen. If the organism is fully susceptible to all the medications the patient is on, then you should suspect noncompliance with medications. Directly observed therapy should be used for these patients. Response to treatment can also be monitored by acid-fast bacilli (AFB) smear examination. This is not as accurate as sputum cultures because even patients who are being effectively treated can still shed nonviable (i.e., dead) AFB for several months after the start of effective therapy. Monitoring by smear is only done when culture monitoring is not possible. Positive smears after five months are indicative of treatment failure.
Serial chest x-rays are not recommended for monitoring responses for follow-up because x-ray changes lag behind, and they are not a sensitive method of detecting treatment failure. You don't want to wait for patients to get sicker in order to tell who has failed therapy. Cultures and smears can detect treatment failure with far greater sensitivity than clinical deterioration. Although blood testing for aminotransferases is recommended at baseline for all patients, these tests do not have to be done routinely during therapy. Repeated testing for elevated transaminases should be performed if there is clinical evidence of illness, the patient is pregnant or an alcoholic, or if the baseline tests are elevated
