Transcript Treatment for Pleural Effusion (Left) probably secondary to:

Treatment for Pleural Effusion
(Left) probably secondary to:
Malignancy or Pulmonary
Tuberculosis
Management of Pleural Effusion
• Treatment may be directed at:
– removing the fluid
– preventing fluid accumulation again
– addressing the underlying cause of the fluid
buildup.
Sean O. Stitham, MD, private practice in Internal Medicine, Seattle, WA; Benjamin Medoff, MD, Assistant Professor of
Medicine, Harvard Medical School, Pulmonary and Critical Care Unit, Massachusetts General Hospital.
Removal of Fluid
• Therapeutic thoracentesis is done if the
following are present:
– fluid collection is large and causing pressure
– shortness of breath or other breathing problems,
such as low oxygen levels
•
Sean O. Stitham, MD, private practice in Internal Medicine, Seattle, WA; Benjamin Medoff, MD, Assistant Professor of
Medicine, Harvard Medical School, Pulmonary and Critical Care Unit, Massachusetts General Hospital.
Effusion secondary to malignancy
• Most malignancies assoc w/ pleural effusion
are not curable with chemotherapy
• Effusion indicates a disseminated disease
• Treated symptomatically
Harrison’s 17th ed. Principles of internal Medicine
If dyspnea compromises Px’s lifestyle, the
ff procedures should be considered :
• Insertion of small indwelling catheter
• Tube thoracostomy with instillation of
slerosing agent such as doxycycline, 500 mg
Harrison’s 17th ed. Principles of internal Medicine
Effusion secondary to PTB
• Goals:
– to interrupt TB transmission
– prevent morbidity and death
Harrison’s 17th ed. Principles of internal Medicine
Isoniazid, Rifampin, Pyrazinamide,
Ethambutol
• First line agents for TB Tx
– Based on:
• Bactericidal activity
• Sterilizing activity
• Low rate of induction of drug resistance
Harrison’s 17th ed. Principles of internal Medicine
Regimens
A. Initial and bactericidal phase
- 2 months of isoniazid, rifampin, pyrazinamide,
ethambutol
B. Continuation or sterilizing phase
-
4 months of isoniazid and rifampin
* A full course of treatment is determined by the total number of doses
taken than by the duration of treatment
Harrison’s 17th ed. Principles of internal Medicine
Recommended Dosage for Initial Treatment of TB in
Adults
Drug
Daily dose
Thrice weekly dose
Isoniazid
5 mg/kg, max 300 mg
5 mg/kg, max 900 mg
Rifampin
10 mg/kg max600 mg
10 mg/kg, max 600 mg
Pyrazinamide
20-25 mg/kg, max 2g
30 – 40 mg/kg, max 3g
Ethambutol
15-20 mg/kg
25-30 mg/kg
Measures to address noncompliance
• Direct Observation of Treatment
– Px are directly supervised esp during the initial
phase
• Fixed Drug Combination
– minimizes the likelihood of prescription error and
the development of drug resistance as the result
of monotherapy