Disease of the Respiratory

system in Children

ShangYunxiao
Department of Pediatrics , The
Second Clinical Hospital , China
Medical University ,
 Introduction
z The disease of respiratory system is one of
the most frequent reasons for hospitalization
of infants and children.
z Basic knowledge of the development and
functions of respiratory system are essential
to understand many of these respiratory
tract diseases.
1.Anatomical characteristics of
respiratory system
z
z (1) The upper airway
z nose;
z paranasal sinuses;
z pharynx;
z Eustachian tube
z larynx
 Nose
z Nose cavity→relatively short and small in
infant;
z The mucous membrane(mucosa) →tender
and soft, rich in vascularity;
z Infection occurs →swelling and congestion
of the mucous membrane → nasal
obstruction →dyspnea.
 paranasal sinuses
z Maxillary sinuses appear at 2yrs, develop
fully after 12yrs.
z Frontal sinuses appear at 2-3yrs, enlarge at
6yrs →Paranasal sinusitis rarely occurs in
infants.
 pharynx;

z Relatively narrow and vertical, rich in

lymphoid tissue.
z Palatine tonsils begin to enlarge gradually at
the end of 1 yrs →develop at 4-10 yrs
→degenerated gradually after 14-15 yrs.
z Tonsillitis is often seen in elder children
than in infants.
 Eustachian tube
z Broad,straight and short in infant;
z The position →horizontal;
z So when an infant catches cold, he may be
complicated with otitis media (tympanitis).
 larynx

z Narrow in infants
z The mucous membrane is rich in vascularity.
z Congested and swollen in inflammation
→dyspnea.
 (2) The low airway
z Trachea;
z bronchus;
z lungs;
 Trachea and bronchus
z The lumen of trachea and bronchus
→relatively narrow;
z Mucosa →rich in vascularity;
z Cillium movement →poor;
z So easy to get infection →develop
obstruction.
z
z The right bronchus →direct continuation of
the trachea;
z The left bronchus spreads out from the
lateral surface of trachea;
z So foreign body →often aspirated into right
bronchus →atelectasis or emphysema of
right lung segment.
 lungs
z Interstitial tissue↑
z Alveoli↓
z Blood ↑
z Air ↓
z →easy to get inflammation →atelectasis.
(3)Mediastinum and chest wall
z mediastinum →relatively larger in infant
than in adult.
z Surrounding tissue of mediastinum →loose
and elastic.
z If the pleural effusion or pneumothorax
occurs →mediastinal organs are easily
displaced.
z The chest wall →short and barrel-shaped
(barrel-shaped thorax or barrel chest)
z The position of diaphragm →high →small
chest cavity,while the lungs are relatively
large, the respiratory muscles are not well
developed →chest wall movement is
limited relatively and the expansion of
lungs are limited during respiration.
z When the respiratory tract disease occur,
exchange of gas →insufficient.
2.physiological characteristics
z (1) Frequency and rhythm of respiration
z The younger the child, the more rapid the
respiration is.
z The metabolism and oxygen requirement of
infants →high, but respiratory volume is
limited →have to increase frequency of
respiration for metabolic requirement.
z When the child begins to stand up and walk
→the diaphram decline gradually to the
level of 5th intercostal space.
z (2)Type of respiration
z In infant → abdominal respiration.
z After the child stands up and walks →the
diaphragm moves downward →the chest
cavity →increased (above 2 yrs)
→abdominal-chest respiration appears.
z (3)Volume of tidal air
z 6 ml per kg when the respiration is
peaceful..
3.The immune characteristics
z The principal antibody in respiratory tract →
z S-IgA
z S-IgA is produced by plasma cells in the
submucosa of airway →can neutralize certain
viruses and toxins, and help the lysis of bacteria.
z The serum levels of IgA remain low during early
childhood →infants and children are susceptible to
infection of respiratory tract.
 Pneumonia
z 1.Classificationof pneumonia
z (1) According to pathological changes
z A: lobar pneumonia
z one or more lobes are involved.
z lobar pneumonia is often present in old
children.
z B: lobular pneumonia
(brochopneumonia):
z lobular pneumonia is the most common
pattern in infants and younger children.
z So it is the focal point in our study.
z C: Interstitial pneumonia :
z (2) According to etiologic agents
z A: virus pneumonia
z Caused by viruses such as respiratory
syncytial virus (RSV), adenovirus (ADV),
cytomegalovirus (CMV), parainfluenza
virus,et al.
z B: Bacterial pneumonia:
z Such as pneumococcal pneumonia,
staphylococcal aureus pneumonia,
colibacillus pneumonia .
z C: Mycoplasma pneumonia .
z D: Others: Fungous pneumonia, Rickettsial
pneumonia, et al.
z (3) According to clinical manifestation
z Mild pneumonia
z Severe pneumonia →heart failure,
respiratory failure, toxic encephalopathy,
toxic intestinal paralysis, DIC.
 Bronchopneumonia
z 1.Etiology of bronchopneumonia
z The incidence of
z Bacterial↓
（pneumococcal,Staphylococcus,
strptococcus, colibacillus)
z Mycoplasma↑
z Viruses (RSV, ADV)
z
2.pathophysiology of bronchopneumonia

z Edema and accumulation of mucus

→bronchiolar obstruction
z Walls of alveoli →thicken
z Alveoli are filled with inflammatory
exudates
z →impairs the normal exchange of gases in
the lungs
z Diminished ventilation of the alveoli
→hypoxemia and carbon dioxide retention
→interfere normal metabolic process and
normal function of the chief organs.
 (1) Hypoxemia
z Normal gas exchange is impaired →PaO2
and Sa O2 ↓
z Cyanosis will appear when
z Sa O2 ↓＜85％
z reduced Hb＞ Hb5g/dl
z flow rate is increased by increase
respiratory frequency and heart rate in order
to compensate the hypoxemia.
z The respiratory failure occurs when PaO2
z ＜50mmHg and PaCO2 ＞50mmHg.
 (2)acid and basic disorder
z PaO2 ↓ →O2 metabolism interruption
→acid metabolic ↑
z →metabolic acidosis.
z PaCO2 ↑(retention of CO2)
z →respiratory acidosis.
 (3)cardiovascular system
z PaCO2 ↑and PaO2 ↓ →reflectory
contraction of pulmonary artery
→pulmonary hypertension.
z Toxemia →toxic myocarditis.
z The pulmonary hypertension and toxic
myocarditis →heart failure.
 (4)Nervous system
z Retention of CO2 and hypoxemia →increase
of capillary permeability →cerebral edema
→central respiratory failure.
z PaO2↓ →acid metabolic products ↑
→ATP ↓ → cerebral edema.
z Toxemia →toxic encephalopathy.
 (5)Digestive system
z Hypoxemia and toxemia→toxic intestinal
paralysis →hemorrhage of gastrointestinal
tract.
 3.Clinic manifestation
z Fever
z Cough dry cough →wet cough
z Dyspnea cyanosis →face, finger nails.
z respiratory distress
z ↓
z grunting, flaring of nares, retractions
z Retractions (supraclavicular, intercostal,
and subcostal areas)
z tachypnea and tachycardia
z Physical examination
z Inspection
z Palpation
z Percussion →dullness
z ↓ confluent and
z pleural effusion
z Auscultation →coarse breath
z breath sound ↓
z dry rales
z moist rales

z
 Severe pneumonia
z A: Congestive heart failure
z B: Toxic encephalopathy
z C:Toxic intestinal paralysis
z D:Disseminated intravascular coagulation
 A: Congestive heart failure
z a. Restlessness, dyspnea becomes more
severe suddenly, paleness or cyanosis.
z b. Heart rate ＞180 /min (infants); ＞160
/min (children); heart sounds becoms low
and dull.
z c. Liver enlarge ＞2cm in a short time.
z d. Edema of face and feet may be
seen.Oliguria or anuria (some patients).
 B. Toxic encephalopathy
z a. irritability, restless, lethargy
z b. convulsion, coma, irregular respiration
and apnea (in severe case)
 C:Toxic intestinal paralysis
z a. Abdominal distension
z b. peristaltic sound disappear

z D:Disseminated intravascular
coagulation
z Bleeding tendency: bleeding at sites of vein
puncture, or scattered petechiae over the skin, or
gastric-intestinal bleeding.
 4. Laboratory finding
z A. White blood cell count (leukocyte)
z pathogen → bacterium ↑
z → virus →normal or slightly
z elevated
z WBC may be normal when the pathogen
is bacterium if the patient is malnutrition or
very severe condition.
z B. Etiologic agent isolated
z from the nasopharygeal secretions
z (deep coughing, tracheal suction, or
z pleural fluid obtained at thoracentesis).
z Blood culture →bacteria pneumonia.
z Serological test →specific antibody to
z virus.
z C. Roengenologic fingings:
z in early stage:
z lung markings ↑
z transparency in lung field↓
z in late stage:
z patch shadows
z emphysema
z or atelectasis
z
 5.Complications
z A. empyema:
z Purulent pleurisy is an accumulation of
pus in the pleural spaces.
z Pathogen →staphylococci, pneumococci.
z Toxic symptom →respiratory difficulty,
limited respiratory movement, dullness to
percussion, breath sounds and vocal
fremitus↓(over the effusion)
z The radiological findings→collection of
fluid in the costaphrenic angles.
z Large collection of fluid →shift of trachea
and mediastinal structure.
z Thoracentesis should be performed when
empyema is suspected, and it is a good
procedure for diagnosis and treatment.
 B. Pyopneumothorax or
tension pneumothorax
z When the small abcess around the lung
breaks, air leaks into thoracic cavity.
z Symptom →severe dyspnea and cyanosis
suddenly;
z percussion →hyperresonance
z auscultation →breath sound↓
z X-ray→air and fluid level
z When tension pneumothorax appears, the
thoracentesis and thoracic drain are required.
 6.Diagnosis
z A. symptoms →fever, cough and dyspnea.
z B.Signs→moist rales in the lung.
z C.Chest X-ray →spotted-like or patchy
shadows over the lung field.
z D.Severe case → Congestive heart failure,
Toxic encephalopathy,Toxic intestinal
paralysis, DIC
z E.Complications →empyema,
pyopneumothorax and pneumatocele.
 7.Differential diagnosis
z A. Acute bronchitis:
z symptoms →mild.
z breath sound →coarse,or a few
rales(sputum) at the end of inspiration and
early expiration.
z Chest X-ray →lung markings↑,
z no spotted or patchy shadows .
z
z B. Bronchial foreign body:
z history → foreign bodies aspiration.
z physical signs → bronchial obstruction,
z sudden onset of cough and wheezing.
z complete obstruction → atelectasis
z incomplete obstruction → emphysema.
z C. Pulmonary tuberculosis:
z Toxic symptom of TB → fever,
diminished appetite, weigh loss, irritability,
malaise, easy fatigability, night sweating.
z ESR↑
z Positive tuberculin test
z history of recent contact with TB
 8.The characteristics of
different types of pneumonia
z A.Staphylococcal aureus pneumonia:
z Pneumonia caused by Staph. aureu is a
serious and rapidly progressive infection,
unless recognized early and treatment
appropriately, the mortality is very high.
z Pathologic changes → extensive areas of
hemorrhagic necrosis.
z Clinical manifestations → abrupt onset with
fever, cough and evidence of respiratory
distress. The sighs include
tachypnea,grunting respiration, three
retractions, cyanosis and restless.
z Convulsion and shock-like state may be
present.
z Some infants may be associated with
vomiting, diarrhea and abdominal distention.
z
z Signs → diminished breath sounds and
z scattered rales are commonly
z heard over the affected lung.
z Complications appear easily → lung
abscess, empyema, pyopneumothorax,
pneumatocele.

z
z WBC increase in peripheral blood with
increased neutrophils.
z X-ray fidings →small patches of shadows
z small abscess.
z Pleural effusion or empyema is noted
during the course in the most patients.
z Sputum or blood culture → Staph.aureu
z growing.
z B.Adenovirus pneumonia
z It occus during the first 2 years of life,
with a peak incidence at approximate 6
months of age. The illness usually occurs
epidemically.
z Pathologic lesion →bronchiolar
z obstruction and interstitial lesion.
z Clinical manifestations →sudden onset with
z higher fever, usually continuous for one
z week, in severe case, the fever lasts for
z 2-3weeks.
z Respiratory distress →wheezy cough,
z dyspnea, pale, restless and cyanosis.
z Sighs →fine rales may be heard a few day
z later.
z Hypoxemia (diminished ventilation of
z alveoli)
z Carbon dioxide retention
z Respiratory acidosis
z In severe cases →toxic encephalopathy,
z congestive heart failur
z toxic encephalopathy
z WBC →usually normal
z X-ray →small patch or perifocal emphysema.
z Igm-ADV →positive
z C.Respiratory syncytial virus pneumonia
z (bronchiolitis)
z It occurs during the first 2 years of life
z with a peak incidence within 6 months of
z age.
z Symptoms and signs →expiratory
z dyspnea, prolonged expiratory time
z expiratory grunting, pallor, restlessness,
z cyanosis and moderate fever.
z Auscultation →expiratory wheezes
z inspiratory moist rales.
z Percussion → hyperresonance sound.
z The liver seems enlarged owing to
z downward displacement of the right
z diaphragm or to congestive heart failure.
z In severe case →hypoxemia
z respiratory acidosis
z respiratory failure
z congestive heart failure
z WBC →usually normal
z X-ray →emphysema
z increased lung marking.
z IgM-RSV →positive
z D. Mycoplasma pneumoniae
z pneumonia(MPP)
z mycoplasma(MP) can cause both upper
z and lower respiratory tract illness →
z bronchiolitis, pneumonia, bronchitis,
z tonsilitis and otitis media.
z MPP usually occurs in elder children(5-
15yeares), and in the climate of autumn and
winter.
z The incubation period →1-3weeks →may
have headache, malaise, cough, fever, sore
throat and muscular pain, or chest pain, loss
of appetite, nausea, vomiting and diarrhea.
z Auscultation →a few dry or moist rales
z locally,
z breth sound ↓(pleural
z effusions)
z WBC →normal or slightly high.
z Serum cold agglutination test →postive
z (highest titer at 2-4weeks)
z Specific antibody to MP (IgM-MP)
z →postive
z X-ray →characterized by cloudy infiltration
z both lower lungs.The shadow sometimes
z wandering (the infiltration disappear in one
z lung and reappear in another lung) →
z lobar, lobular, interstitial changes.
 9.Treatment
z Principles of treatment →
z Control the inflammation;
z Improve ventilation;
z Prevent complications

z
 (1) General treatment
z A. Keep the ventilation well, relieving
hypoxia and CO2 retention.
z when the secretion in airway is thick
→intermittent ultrasonic inhalant therapy is
recommended.
z NS 20ml＋gentamycin 4000u ＋
z Dexamethason 2mg ＋α-chymotrypsin
z 5mg.
z Sputum suction in time →best way to keep
normal ventilation of airway.
z B. Oxygen therapy
z oxygen inhalation can be administrated
z with nasal cannula, the flow is
z 0.5-1L/min.
z If the hypoxia continues →Oxyhood
z may be used with a flow of 2-4L/min.
z when respiratory failure occurs →
z ventilator is needed.
 (2)antibiotics
z The selection of antibiotics depends on →
z the degree of illness and the kinds of
bacteria.(the best way →give the most
sensitive antibiotic to the bacteria by
medicine sensitive test)
z intramuscular antibiotics →mild cases;
z intravenous antibiotics →severe cases
z Pneumococcal pneumonia →penicillin
z 300,000-600,000u /kg.d Bid iv.
z Staphylococcal aureus pneumonia
z →Oxacillin,50-100mg /kg.d q6h iv.
z Colibacillus pneumonia →Amicillin,
z 50-100mg /kg.d bid iv.
z or Amikacin,15mg /kg.d, bid iv.
z Viruspneumonia →
z Virazole,10-15mg /kg.d qd iv.
z Interferons, 20000u, qd im (injection
z intramuscularity), for 3 days.
z Chinese traditional medicine
z (双黄连, 穿琥宁等)
z Mycoplasma pneumoniae pneumonia →
z erythromycin 20-30mg /kg.d qd iv
z drip
z The principle of discontinue antibiotics:
z The signs of lungs have disappeared for 3 days,
no fever and cough.
z Mycoplasma pneumoniae pneumonia →
z usually 2-3weeks or longer.
z Staphylococcal aureus pneumonia →shoud be
treated with a long course, the antibiotics should
be used for another 2 weeks if the signs of lungs
have disappeared and no fever .

z
 (3)Symptomatic treatment
z A. Sedate
z if the patient is restless (dysphoria), some
sedative should be used, such as:
z 5％ chloride hydras 1ml /kg, po (orally)
z or enema.
z PCP 1mg /kg, im or iv.
z Valum 0.1-0.3mg /kg, im or iv.
z
z
z B.Control of heart failure:
z The following cardiotonnic drug is used:
z a. Strophanthin K, 0.007-0.01mg /kg, iv.
z b. Cedilanid
z total digitalizing dose 0.03-0.04 mg /kg,
z half od the total dose is used initially;
z after 6 hour,1 /4 of total dose is used
z again; the final 1 /4 of total dose is used
z another 6 hour later.
z The daily maintaining dose → 1 /4 of total dose.
z The way of administation may be im or iv.
z C. Dehydration;
z Furosemide, 1mg /kg, im or iv;
z 20％Mannital 5ml /kg, q12h iv (used in
toxic encephalopathy)
 (4)Treatment of complication
z Empyema
z Pyopneumothorax
z →thoracentesis and thoracic drain
 (5)Supportive treatment
z A. Inhale clean air;
z B. good and enough nutrition;
z C.Elevate resistance of the body
z ( Ig, plasma or blood )
 Tuberculosis in children
z Tuberculosis (TB) is a chronic infectious
disease caused by tubercle bacillus.
z Primary TB is the chief type in children.
z Many cases of TB continue to occur in our
country, so TB remains an important
clinical problem in China.
 1.Etiology
z The tubercle bacilli belong to the
z ↓
z mycobacterium
z ↓
z The stain has a property of acid-fastness.
 2.Epidemiology
z Infants and children are most frequently
infected by adult, usually close relative such
as the members of the household.
z The mode of infection consists of three
routes:
 (1)From respiratory tract:
z Inhale the droplets of sputum, expelled by
the infectious individual during his
z coughing
z sneezing
z even talking
 (2) From alimentary canal:
z Bovine tuberculosis is acquired by way of
the oral route, such as:
z ingestion of raw milk from infected
cows;
z ingestion of contaminated foods by
tubercle bacillus;
z Pasteurization can destroy infectivety of
contaminated milk.
(3)From the skin or placenta
 3.The allergic reaction and
immunity of TB
z pathogen(tubercle bacillus)
z ↓through infective route
z child
z ↓
z the thymus-dependent LC be sensitized and
proliferates
z ↓ ↓
z 4-8weeks↓ ↓
z delayed allergic reaction↓
z ↓ ↓
z positive tuberculin test ↓contact
z ↓tubercle
z ↓bacillus again
z Lymphokines
z ↓ ↓
z ↓ ↓
z Activating factors Inhibiting factors
z of macrophage of macrophage
z ↓ movement
z ↓ ↓
z activating Tubercle bacillus is
z macrophage surrounded by sensitized TLC
z ↓
z ↓

z
z (activating macrophage)
z ↓
z Engulf and kill tubercle bacillus
z ↓produce
z Epithelioid cells and tubercle
z ↓
z infection is focused

z
4.Diagnosis
 (1) History
z TB toxic symptoms;
z →fatigue,cough or hemoptysis,
z fever, malaise, loss of weigh,
z night sweats.
z The history of contact with active TB;
z The history of vaccination of BCG (Bacilli
z Calmette-Guerin)
 (2)Tuberculin test
z Four to eight weeks after infection with
tubercle bacilli, an allergic reaction can be
seen on the site of intracutaneous injection
of tuberculin, which belongs to delayed
allergic reactio.
 A.Method
z Performed by the intradermal injection
0.1mL PPD (protein purified derivative)
z into cleaned skin of the forearm. A pale
elevation of the skin, 6-10mm in diameter,
shoud be produced immediately after
injection. If the wheal is smaller than
6mm,the injection should be repeated at
another site.
 B. Reading and recording of
the test
z The test should be read during 48-72 hours
after injection. Reading should be made in a
good light, the forearm slightly flexed. The
basis of reading is the presence of
induration that may be determined by
inspection and by palpation with a gentle
finger stroking.
z The diameter of induration should be
measured transversely to the long axis and
recorded in millimeters.
z The erythema without induration is of no
significance.
z
 C. Judge standard
z The diameter of induration
z ＜5mm (-) negtive
z 5-9mm (＋)
z 10-20mm (＋ ＋)
z ＞20mm(＋ ＋ ＋)
z induration with blisters and necrosis
z (＋ ＋ ＋ ＋)
 D.Clinical significance

zPositive reaction:
z a. Vaccinated with BCG before 4-8 weeks.
z b. Infected with tubercle bacillus but no
z active focus of infection was found.
z c.Suffering from active of TB (＞20mm).
z d.There is new focus of TB in infant and
child (＜ 3years), the younger the child, the
more possible the active TB is
z e. Positive conversion (Mantoux conversion)
from negative result within 2years, or the
diameter of induration enlarged from ＜
10mm to ＞10mm, suggesting a new
infection or an active focus of TB.
z Negative reaction
z a. Does not infect with the tubercle bacillus
(including the failur of vaccination with BCG).
z b.Immunoreaction is suppressed
z ①Severe tuberculosis (active miliary TB
z of the lung)
z ②Infected with some virus within 1
z month, such as measles, rubella and
z influenza.
z ③Vaccinated live measles vaccine within
z 2-3 weeks
z ④Using immunosuppressor.
z ⑤Sever malnutrition.
z ⑥Primary immunodeficiency.
z The differentiation of vaccination of
BCG and infection by TB
z with BCG by TB
z The diameter weak reaction strong reaction
z of induration D ＜5-9mm D ＞10-15mm
z Lasting ofinduration short, ＜2-3d 7-10d, or above
z Characteristics of soft, hard with clear
z the induration no clear limit limit, dark red
z Lasting of short, 3-5 years very long,
z immunoreaction 10-20years
 (3)Laboratory findings
z A. Tubercle bacillus may be found in the
sputum, gastric juice, CSF,pleurorrhea and
ascetic fluid.
z B. Biopsy of peripheral lymph node may
show tubercle, caseation and Langhan’s
cells.
z C. Increased WBC and decreased RBC
z D. Erythrocyte sedimentation rate accelerate.
z E. Chest X-ray : Varioud clinical types of
intrathoracic shadows can be found which is
helpful for diagnosis and treatment.
z F. Immunology diagnosis and biological gene
diagnosis
z ELISA, ELIEP,
z PCR (polymerase chain rection)
z DNA probe (hybridization)
z
 5.Prevention
z (1) Avoid contacting with tubercle bacilli.
z (2) Enhance natural resistance of body:
z A. physical exercise
z good nutrition
z good enviroment
z prevent infective disease
z B. Vaccinate BCG vaccine
z The vaccine is composed of Bovine tubercle
bacilli whose virulence has been reduced by
spicial cultural procedures.Administrated BCG to
human being to produce a limited immunity
against the reinfection.
z Intradermal injection is effective.
z The vaccine is given during the first few days od
life. Vaccine shoud be repeated in 3,7 and 12
years old.
z (3)Preventive treatment with drug;
z Isoniazid 10mg/kg.d for 6-12 months.
z The indications:
z A. Younger than 3 years of age,no
z vaccination with BCG, PPD test shows a
z positive result recently.
z B. Contacting with TB patient frequently
z and closely
z C.No vaccination of BCG, but has a
z positive conversion from negative.
z D. Tuberculin test is strong positive.
z E. Having a history of TB or an old focus of
TB in the lung, and need using
immunosuppresor for long time.
 5.Treatment
z The most useful drugs in the treatment of
TB are:
z Isoniazid (INH) 异烟肼
z Rifampin(RFP) 利福平
z Ethambutol(EMB) 乙胺丁醇
z Ethionamide (ETH)乙硫异烟胺
z Streptomycin(SM) 链霉素
z Pyrazinamide(PZA)吡嗪酰胺
z Dipasic 力排肺疾（新药）
 Treatment
z Purpose →
z a. Kill tubercle bacillus in the focus.
z b. Prevent dissemination from blood.
z Principle →
z Early, Regular, Enough course,
z Combined therapy, Proper dose,
z Different period treatment.
 (1)Tuberculocide
z A. Highly active → INH, RFP
z have a strong penetration, can kill tuberculosis
whatever intra-macrophage or extra-macrophage.
z B. Partly active →SM, PZA
z SM →only against the extra-macrophage
tubercle bacilli that are active metabolism and in
the alkaline condition.
z PZA →only against the intra-macrophage
tubercle bacilli that are low metabolism and in the
acid condition.
 (2)Tuberculostatic
z EMB
z Ethionamide (ETH)
 The way of treatment
z (1) Standard treatment
z → usually suitable for primary
z pulmonary tuberculosis
z lasting for 9-12 months with INH,RFP and
(or) EMB
z (2)Two period treatment
z →suitable for active Primary pulmonary
z tuberculosis, Acute miliary TB of lungs,
z Tuberculous meningitis.
z A. strengthen period →kill the activing
z tubercle bacilli quickly, 2-4 kinds of
tuberculocide drugs are needed, such as
INH ＋RFP ＋SM or INH ＋ RFP ＋ EMB.
z (3-4 month)
z B.Consolidating period →kill the surplus
z tubercle bacilli and prevent relaps.
z INH ＋ RFP → INH ＋ EMB(acute
z miliary TB of lungs);
z INH ＋ RFP ＋ EMB → INH ＋ RFP or
INH ＋ EMB(tuberculous meningitis)
z
z (3) Short period treatment
z 2HRZ/4HR(INH ＋RFP ＋PZA for two
months, INH ＋RFP for four months)
z 2SHRZ/4HR(SM ＋ INH ＋RFP ＋PZA for
two months, INH ＋RFP for four months)
z 2EHRZ/4HR(EMB ＋ INH ＋RFP ＋PZA for
two months, INH ＋RFP for four months)
z