Respiratory

Tuberculosis (OPD Approach)

ٹی بی / تپ دق

Low-grade fever, cough for more than 2 weeks, night sweats, weight loss, loss of appetite and sometimes haemoptysis. Confirm with sputum AFB and chest X-ray, check GeneXpert for MDR-TB, then start ATT by weight and refer to a consultant for further decision.

ICD-10: A15
Source: OPD handbook pp.169–171
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Fever: low grade
Cough: more than 2 weeks
Night sweats / weight loss
Loss of appetite
Haemoptysis (blood in sputum)

Diagnosis

Examination: pallor may be present; emaciated look
Sputum for AFB (acid-fast bacilli, microscopy)
CXR (PA view)
GeneXpert (to check for MDR-TB, i.e. multidrug-resistant TB)

Treatment

Step 1 of 3

1. Start while working up

After history and examination, start symptomatic treatment
Advise work-up: CXR and sputum for AFB

Prescription

LevofloxacinFluoroquinolone antibiotic

Dose1+1

Brand Tab L-Cyn 250 mg (levofloxacin)

Also sold as L-Cyn, Leflox, Efflox (spelling unclear in book), Levo

Paracetamol (Acetaminophen)Analgesic / antipyretic

Dose2+2+2 as needed

Brand Tab Panadol 500 mg

Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)

Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease

Terbutaline (expectorant/bronchodilator syrup)Beta-2 agonist

Dose2+2

Brand Syp Britanyl

Also sold as Britanyl, Bricanyl, Muconyl

Step 2 of 3

2. If AFB is positive: calculate weight and start ATT

ATT (antituberculous therapy), adults.

Tab Myrin P Forte, early in the morning: weight up to 39 kg → 2 tablets; 38–54 kg → 3 tablets; over 54 kg → 4 tablets (the ranges overlap at 38–39 kg in the book)
Tab Vita-6 50 mg (pyridoxine) 1+0 at night; continue
Tab Panadol 500 mg as needed
Syp Britanyl / Hylixia 2+2
Supplements if needed
Refer to a consultant for further decision

Prescription

Rifampicin + Isoniazid + Pyrazinamide + Ethambutol (fixed-dose combination)Anti-TB fixed-dose combination

Dose≤39 kg: 2 tablets; 38–54 kg: 3 tablets; >54 kg: 4 tablets, early in the morning

Brand Tab Myrin P Forte

The book dose is by weight: up to 39 kg 2 tablets; 38–54 kg 3 tablets; over 54 kg 4 tablets, early in the morning.

Pyridoxine (vitamin B6)Vitamin

Dose1+0 at night, continue

Brand Tab Vita-6 50 mg

Also sold as Pyridoxine, Vita-6

Paracetamol (Acetaminophen)Analgesic / antipyretic

Dose1–2 tablets as needed

Brand Tab Panadol 500 mg

Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)

Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease

Terbutaline (expectorant/bronchodilator syrup)Beta-2 agonist

Dose2+2

Brand Syp Britanyl

Also sold as Britanyl, Bricanyl, Muconyl

Ivy leaf extract (cough syrup)Herbal cough suppressant / expectorant

Dose2+2

Brand Syp Hylixia

Also sold as Prospan, Samvy, Hylixid, Coferb Plus, Hylixia

Step 3 of 3

3. Counselling (Urdu notes)

Wear a mask for 6 months
Keep the patient's eating utensils separate
Get the other family members screened (checked)
Refer to a consultant physician

Sample prescription from the book (patient details removed)

Male, 62 y, 52 kg, fever and productive cough for 2 months with one episode of haemoptysis; sputum for AFB positive; CXR shows perihilar lymphadenopathy: Tab Myrin P Forte 3 tablets early in the morning; Tab Vita-6 50 mg 1 at night; Tab Panadol 500 mg 2 tablets as needed; Syp Hylixia 2+2; wear a mask for 6 months; separate utensils; screen family members; refer to a consultant physician.