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.