Objectives Disseminate info on TB in India Improve care of TB patients in India Enable doctors and NGO's interested in TB control to interact

The flow chart shows the management approach in HIV patients who fail to respond or deteriorate while on anti-TB treatment

	Patient fails to respond or deteriorates on TB treatment
	Send sputum and do chest X-ray
Sputum test			Chest x-ray result
Smear for AFB	TB culture	Gram stain and culture for bacterial pathogens	Diffuse interstitial shadowing New cavities(Sputum AFBs negative			New cavities (sputum AFBs negative)
Treatment failure	Drug resistance	Bacterial pneumonia	Pneumocystis carinii pneumonia		Nocardia suspected
retreatment regimen	Refer to specialist centre	antibiotics(see below)	TMP-SMX 4 tablets 4 times daily for 3 weeks then prophylaxis 2 tablets daily

The table below shows the main bacterial pathogens responsible for superimposed pneumonia in smear positive pulmonary TB patients and the treatment

Pathogen	Treatment
Streptococcus pneumoniae	Penicillin or TMP-SMX
Haemophilus influenzae	Amoxycillin or TMP-SMX
Staphylococcus aureus	flucloaxacillin or chloramphenicol
Gram negative bacilli	Chloramphenical and Gentamycin if necessary

TMP-SMX=Trimethoprim Sulphamethoxazole
Source:  TB/HIV A clinical manual WHO/TB/96-200

Warning The information above is for doctors only. Others should see their doctor and get appropriate treatment. Self diagnosis and treatment may lead to dangerous consequences