Discussion of management
Upon confirming the diagnosis of acute necrotizing granulomatous
bronchitis, strongly indicative of endobronchial and pulmonary
tuberculosis, the patient’s management and treatment plan were promptly
initiated to address the underlying infectious pathology. The
cornerstone of treatment for pulmonary tuberculosis involves
antitubercular therapy aimed at eradicating the causative agent,
Mycobacterium tuberculosis. The patient was commenced on a standard
multidrug regimen consisting of first line antitubercular agents,
including Isoniazid (INH), Rifampicin (RIF), Pyrazinamide (PZA), and
Ethambutol (EMB). The initial phase of treatment typically involves a
combination of these drugs administered for a duration of 2 months,
followed by a continuation phase with INH and RIF for an additional 4
months (24). The dosage of each medication was carefully calculated
based on the patient’s weight and adjusted for any underlying
comorbidities or contraindications (Table 2).
Given the importance of treatment adherence and the potential for
medication noncompliance, a direct observation strategy was implemented
to ensure the patient’s compliance with the prescribed antitubercular
regimen. Healthcare professionals or trained personnel closely monitored
and supervised the patient’s medication intake to optimize treatment
adherence and minimize the risk of treatment failure and drug
resistance.
Table 2. First Line Drugs Used in the Treatment of Adults with TB Based
on the ATS/ CDC/ IDSA Guidelines.