leptospirosis presentation
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Differences between AKURIT and
conventional TB drugs.AKURIT is one of the fixed dose combinations for anti TB medications.The 2 FDCs available in MOH Drug formulary for adult are:
4drugs combination : INH 75mg, RIF 150mg, PZA 400mg and EMB
275mg
3 drug combination : INH 75mg, RIF 150mg, PZA 400mg
The recommended dosage for the 2 FDC are
30 - 37 kg body weight: 2 tablets daily
38 - 54 kg body weight: 3 tablets daily
55 - 70 kg body weight: 4 tablets daily
More than 70 kg body weight: 5 tablets daily
FDC help reducing the emergence of drug resistance TB and reduce pillburdens for patient and increase patient adherence to medication.
The conventional TB drugs is the separation of anti TB drugs and its normally
used if patients developed drug toxicity, intolerance or contraindications to its
component.
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Treatment and prophylaxis for PCPPCP prophylaxisOne double strength of cotrimoxazole daily or dapsone 100mg daily if
cotrimoxazole is contraindicated.
The duration of prophylaxis is until the CD4 count > 200 for 3 months
PCP treatment
Trimetoprim 15-20mg/kg /day plus sulfamethoxazaole 75-100mg/kg/day in
QID or TDS
Treatment duration is 21 days.
National antibiotic guideline 2008 & the National Institutes of Health, and the HIV
Medicine Association of the Infectious Diseases Society of America.
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Treatment duration for syphilisTreatment of primary and secondary syphilis among HIV infected patients in
benzathine penicilline G, 2.4 mu intramuscular in a single dose.
Most HIV positive pateints who have early syphilis might be at risk for
neurologic complications. Based on the national antibiotic guideline 2008,
patients infected with HIV with syphilis should be treated as neurospiphylis.Benzylpenicillin 3-4 mu 4 hourly for 14 days.
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Clinical
Case PresentationHIV-TB co-infection
By Khairuzzaman
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Patient Details
Name: Mr S
RN: HTJ 476731
Age: years old Race: Malay
Gender: male
DOA: 21/11/13 Weight: 95 kg
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Chief complaint
Fever and referred from private clinic
History of Presenting Illness
Fever for 2 days
Arthralgia for 1 day
Vomiting 2 times per day
Low of apatite for 2 days Lives at dengue area
Exposed to rat at home
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Social History Chronic smoker
History of alleged MVA in 1997, claimed laser done for
blood clot
Review of System
BP 89/28
PR 110
Temp 39.8
Spo2 100
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Provisional Diagnosis
1. Septic shock secondary pneumonia
2. TRO dengue fever
Diagnosis
1. leptospirosis
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Leptospirosis
Causal agent: leptospira genus (longcorkscrew-shaped bacteria). It is too thin to be
visible under ordinary microscope.
Mode of transmission: domestic animal arethe reservoir of the agent and transmitted
through contact with the urine membranous
or broken skin with water or foodcontaminated with urine of the infected
animals.
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Laboratory results:
FBC Reference range 21/11 22/11
TWBC 4-11x10/L 9.4 5.7
HB 11.5-16.5
g/100mL
14.1 13.6
Platelet 150-400 g/100mL 198 166
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Renal
profile
Reference range 21/11 22/11 25/11
Urea 1.7-8.3 mmol/L 3.7 2.1 5.6
Na+
135-145 mmol/L 132 134 126K+ 3.5-5.0 mmol/L 3.9 2.8 4.0
SCr 64122 mmol/L 104 101 112
CrCl 105-150 ml/min
PO4- 0.8-1.45 mmol/L 0.5
Ca2+ 2.12.6 mmol/L 2.07
Liver profile Reference
range
21/11 22/11 25/11
Albumin 35-50g/L 31 32 32
T. Bilirubin
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Ward medicationDrug Date
start
Date
stop
Indication
IV CEFTRIAXONE 1G BD 21/11 21/11 Empirical therapy for CAP
IV CEFTRIAXONE 2G OD 21/11 Empirical therapy for CAP
T AZITHROMYCIN 500MG
OD
22/11 Empirical therapy for CAP
T. PARACETAMOL 1G STAT 22/11 Antipyretic
IV TRAMADOL 50MG STAT
TDS
23/11 Analgesic
IV METOCHLORPRAMIDE
10MG STAT
23/11 Antiemetic
IV OMEPRAZOLE 20MG BD 25/11 Gastritis
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Pharmaceutical
Care Issue
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Inappropriate drug management
Patient was provisionally diagnosed with sepsis secondary to
pneumonia and treated with IV ceftriaxone 2g od and T.
azithromycin 500mg od. On 22/11 patient was confirmed with
leptosirosis based on the leptospirosis antibody test.
Prescriber still continue the treatment with 2g of ceftriaxone
Recommendation
Suggest to reduce the dose of ceftriaxone to 1g od.
Outcome and monitoring parameters.
Prescriber still continued the ceftriaxone 2g od.
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