Follow-up care
Compliance is a major determinant of the success of drug treatment - compliance of the phycisian in prescribing the optimum appropriate regimen and monitoring it, and compliance of the patient in taking the medication as prescribed. Drug toxicity is more likely if non-stardard regimens are used. Respiratory physicians and infectious disease specialists are significantly more likely to prescribe the recommended stardard chemotherapy than clinicians from other specialities.

Children should be managed either by a paediatrician with special experience and training in tubrculosis, or by a general paediatrician collaborating with an appropriately trained physician.

As far as patients are concerned, language spesific, culturally sensitive material, appropriate for the educational level of the patient and their family must be provided. An early educational effort facilitates contact or associate investigations that must accompany effective therapy. Patients should be supplied with written instructions for medication administration, duration of therapy, renewal of prescriptions, the name, telephone number and location of a health care worker to serve as a resource for addressing emergent problems or questions. Medical follow-up every 6-8 weeks should be scheduled to monitor the side effects of medications, compliance and response to therapy. An organized system of recalls for missed appointments should also be arranged.

DOT should be used for the treatment of all tuberculosis disease in children. If DOT cannot be applied compliance could be achieved only by getting close to the patient’s family, by thoroughly informing the parents and by the development of mutual trust.

Routine testing of liver funtion before or during therapy is not indicated except in situations of severe tuberculosis disease (miliary, meningitis), malnutrition or coadministration of other hepatotoxic drugs, and finally if there are symptoms such as nausea, vomiting etc.

Intrathoracic lymphadenopathy requires 2 to 3 years to/if resolve. A follow-up chest roentgenogram at 2 months and the end of therapy is appropriate to confirm either resolution, aggravation or no change and to serve as a baseline if future evaluation is clinically indicated. Repeat TST is not indicated.

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