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Pulmonary · Ward Pathways · Locked — free with a referral
By Dr Javed Akhtar · Last reviewed 2 October 2026
Presentation 32-year-old, 2 months of cough, evening fever, 8 kg weight loss, streaky haemoptysis; right upper lobe cavity; sputum GeneXpert MTB detected, rifampicin resistance not detected
Red flags Massive haemoptysis Respiratory failure Meningitis features Jaundice on ATT BMI <16 Differential diagnosis Bacterial pneumonia / lung abscess Lung cancer Melioidosis Fungal (aspergilloma, histoplasmosis) NTM infection When to admit, call ICU or discharge Admit: Massive haemoptysis, respiratory failure, TB meningitis/miliary, severe malnutrition, DILI, HIV with OI, social inability to isolateICU: Respiratory failure, massive haemoptysis, hepatic failure, TB meningitis with ↓GCSKey points India carries about a quarter of the world's TB; every case is notifiable and treatment is free under NTEP. Ethambutol → optic neuritis; isoniazid → neuropathy (pyridoxine); rifampicin → orange secretions and major drug interactions; pyrazinamide → gout, hepatitis. Household contacts get TB preventive treatment after active TB is excluded. Never Start ATT without sending sputum for NAAT/culture Give a fluoroquinolone "trial" for suspected TB-pneumonia Reintroduce all hepatotoxic drugs together after DILI Forget HIV testing and contact screening Common mistakes Treating without microbiology Missing rifampicin resistance No HIV test Poor DILI handling Disposition and follow-up Most TB is treated at home under NTEP; admit for the complications above. DOT/treatment supporter and nutrition support.
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