03-15-2007, 11:21 AM
A 56-year-old recent Vietnamese immigrant comes to a community outreach health center complaining of a hacking cough associated with fever and night sweats that has lasted for the last 3 months. Because there as been a recent outbreak of isoniazid-resistant tuberculosis in the Vietnamese community there is a heightened concern that the patient has active pulmonary tuberculosis. He is admitted to the hospital and placed in isolation. Over the next few days, three sputum smears reveal acid-fast staining organisms consistent with Mycobacterium species, and a chest radiograph shows a 3-cm, right upper lobe cavitating lesion. Which of the following is the most appropriate management?
A. Begin rifampin, pyrazinamide, and ethambutol for a 6-month course of treatment
B. Delay starting therapy until culture and sensitivity data is available
C. Initiate four-drug treatment that does not include isoniazid; treat for 6 months
D. Place purified protein derivative (PPD); delay treatment until PPD results are available
E. Start isoniazid, rifampin, pyrazinamide, and ethambutol until sensitivities are available
A. Begin rifampin, pyrazinamide, and ethambutol for a 6-month course of treatment
B. Delay starting therapy until culture and sensitivity data is available
C. Initiate four-drug treatment that does not include isoniazid; treat for 6 months
D. Place purified protein derivative (PPD); delay treatment until PPD results are available
E. Start isoniazid, rifampin, pyrazinamide, and ethambutol until sensitivities are available