 | TB/HIV: a Clinical Manual (WHO - OMS, 1996, 135 p.) |
 |  | Chapter 10 - Management of other HIV-related diseases in TB/HIV patients |
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10.5 Respiratory problems
Some TB/HIV patients fail to improve, or even deteriorate, during anti-TB treatment. They continue to have, or develop new, respiratory problems, e.g. cough, breathlessness, chest pain. First check that the patient has really been taking his anti-TB drugs. Then consider the following possibilities:
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ORIGINAL DIAGNOSIS |
POSSIBILITIES |
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sputum smear-negative PTB. |
incorrect diagnosis e.g. other pathogens, heart failure, chronic obstructive airways disease |
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sputum smear-positive PTB. |
patient not adherent to anti-TB treatment; drug-resistant TB; super-imposed infection with other pathogens. |
The flow chart shows the management approach in HIV-positive PTB patients who fail to respond or deteriorate while on anti-TB treatment
Figure
The table below shows the main bacterial pathogens responsible for super-imposed pneumonia in smear-positive PTB patients and the treatment.
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PATHOGEN |
TREATMENT |
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Streptococcus pneumoniae |
penicillin or TMP-SMX |
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Haemophilus influenzae |
amoxycillin or TMP-SMX |
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Staphylococcus aureus |
flucloxacillin or chloramphenicol |
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Gram-negative bacilli |
chloramphenicol (and gentamicin if necessary) |
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