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REFLEKSI KASUS

Diah Saraswati
13223

Indentitas

Nama
: Tn. S
Jenis kelamin : laki-laki
Usia
: 39 tahun
Alamat
: Sukaraja Kulon, Banyumas
Tanggal masuk: 24 Januari 2014

Keluhan Utama

Riwayat Penyakit Sekarang

Riwayat

Anamnesis sistem

Resume Anamnesis

Pemeriksaan Fisik

Paru

Kanan

Kiri

Inspeksi

Simetris (+), ketertinggalan gerak (-), retraksi (-),


penggunaan otot bantu nafas (+)

Palpasi

Pengembangan dada
simetris, pelebaran sela
iga (-), nyeri tekan (-),
fremitus taktil normal

Pengembangan dada
simetris, pelebaran sela
iga (-), nyeri tekan (-),
fremitus taktil menurun

Perkusi

Sonor (+)

Redup (+)

Auskultasi

Vesikuler (+) normal,


RBB (-), wheezing (-)

Vesikuler (+) menurun ,


RBB (+), wheezing (-)

Abdomen

Differential diagnosis

Pemeriksaan Penunjang
Darah Rutin

AL : 11.800
AE : 5.38 x 10^6
Hb : 14.5 g/dl
Hct : 40.7%
AT : 494.000

Neu : 9.17
Lymp : 1.57
Mono : 0.979
Eo : 0.035
Baso : 0.073

Rontgen Thorax
Terdapat perselubungan
semiopak inhomogen pada kedua
apeks paru disertai adanya
kavitas di paru sinistra
Terdapat adanya gambaran
semiopak kasar di sisi lateral
paru
Terdapat gambaran opak
homogen di paru sinistra,
Sudut costophrenicus sinistra
tidak terlihat, sudut
costophrenicus dextra lancip
CTR tidak dapat diukur
Sistema tulang tervisualisasi
intak
Kesan : TB Paru dengan efusi
pleura sinistra

Diagnosis

Pengelompokan OAT

Sifat OAT

Dosis OAT Kombipak

Pengobatan Kasus Khusus


Kehamilan

Gagal Ginjal

Treatment of TB
Kategori

Pasien TB

Regimen Terapi TB
Fase inisial
Fase lanjut
2 HRZE
4 HR
4 (HR)3
optional
optional
2HRZE
6 HE
Optional
optional
2 (HRZE) 3
4 (HR)3

BTA positip, BTA negativ lesi


luas, HIV positif, ekstra paru
berat.

III

BTA negative, ekstra paru tidak 2 HRZE


berat
optional
2 HRZE
Optional
2 (HRZE)

4 HR
4 (HR)3
optional
6 HE
optional
4 (HR)3

(WHO, 2004)

Kategori

Pasien TB

II

Relap, Terapi setelah Default

II

Gagal Terapi Kategori I, setting:


-TB MDR rendah
Tidak ada fasilitas kultur MDR

2HRZE/1 HRZE 5 HRE


Optional
5 (HRE)3
2
(HRZES)3/1(HR
ZE)

II

Gagal Terapi Kategori I, setting:


-TB MDR tinggi
tersedia obat second line
Kronik, suspect MDR

Obat diberikan secara individual


berdasarkan hasil sensitivitas test
dengan obat second line
Obat diberikan secara individual
berdasarkan hasil sensitivitas test
dengan obat second line.

IV

Regimen Terapi TB
Fase inisial
Fase lanjut
2
5 HRE
HRZES/IHRZE 5 (HR)3
optional
2(HRZES)3 /
1(HRZE)3

Possible Alternative Treatment Regimens for


EachTreatment Category (WHO Guidelines)
TB
Treatment
Category

II

III

IV

Alternative TB Treatment Regimens


TB patients

Initial phase (daily or 3


times/week)

Continuation phase

New smear-positive PTB;


New smear-negative PTB with extensive
parenchymal involvement;
New cases of severe forms of extrapulmonary TB

2 EHRZ (SHRZ)
2 (EHRZ (SHRZ)

6 HE
4 HR

2 EHRZ (SHRZ)

4 H3R3

2 SHRZE / 1 HRZE
2 SHRZE / 1 HRZE

5 H3R3E3
5 HRE

2 HRZ
2 HRZ
2 HRZ

6 HE
4 HR
4 H3R3

Sputum smear-positive;
Relaps;
Treatment failure;
Treatment after interruption.
New smear-negative PTB (other than in
category I) new less severe forms of
extrapulmonary TB
Chronic case (still sputum-positive after
supervised retreatment)

Not application
(Refer to WHO guidelines for use of second-line drugs
in specialized centres)

Daily Dosage
Essential Anti-TB
Drug (abbreviation)

Isoniazid (H)
Rifampicin
Pyrazinamide (Z)
Streptomycin (S)
Ethambutol (E)
Thioacetazone (T)

Mg/day
Adult 70 kg
bodyweight

Child 25 kg
bodyweight

350
700
1750
1050
-

125
250
625
375
-

Standardised Treatment Regimens by


WHO (The essential anti-TB drugs)
Essential Anti-TB
Drug (abbreviation)

Recommended dose (mg/kg)


Daily

Isoniazid (H)
Rifampicin
Pyrazinamide (Z)
Streptomycin (S)
Ethambutol (E)
Thioacetazone (T)

5 (4-60
10 (8-12)
25 (20-30)
15 (12-18)
15 (15-20)
2.5

Intermittent
3 times/week

2 times/week

10 (8-12)
10 (8-12)
35 (30-40)
15 (12-18)
30 (25-35)

15 (13-17)
10 (8-12)
50 (40-60)
15 (12-18)
45 (40-50)

Not applicable

Tabel 4. Rekomendasi dosis harian OAT lini pertama

Isoniazid (H)
Rifampicin (R)
Etambutol (E)
Pyrazinamid (Z)
Streptomycin (S)

< 33 Kg

33-35 Kg

51-70 Kg

>70 Kg

4-6 mg/Kg
10-20 mg/Kg
25 mg/Kg
30-40 mg/Kg
15-20 mg/Kg

200-300 mg
450-600 mg
800-1200 mg
1000-1750 mg
500-750 mg

300 mg
600 mg
1200-1600 mg
1750-2000 mg
1000 mg

300 mg
600 mg
1600-2000 mg
2000-2500 mg
1000 mg

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