Oct 11, 2015
5/21/2018 PNPK TB
1/120
5/21/2018 PNPK TB
2/120
5/21/2018 PNPK TB
3/120
!"#$%&' )&*+$'&,!",&-&'&' ."#$/0"1&'
2&0& 3&/*&'& 245"1/4,$*+*
!"#$
!%&%'(%#)"' !%$%+"("' #)
,-./
5/21/2018 PNPK TB
4/120
Disclaimer
Buku ini didanai oleh United States Agency for International Development dibawah
USAID Tuberculosis CARE I, Cooperative Agreement No. AID-OAA-A-10-00020
Buku ini menjadi mungkin berkat dukungan yang baik dari rakyat Amerika melaluiUnited States Agency for International Development (USAID). Isi menjadi tanggung
jawab TB CARE I dan tidak mencerminkan visi USAID atau Pemerintah AmerikaSerikat.
5/21/2018 PNPK TB
5/120
vPedoman Nasional Pelayanan Kedokteran
!"(" 0%'1"'("#
!
"#$"%&'( *%+,-(.(" "%/(+( .%01 #%"/(" 2,*3(4 -(&'%" 5,6%+.,3$&'& 5%+6("7(. #' #,"'(8
9%"/$6(5(" 5,6%+.,3$&'& *%+,-(.(" &(3(4 &(5, :(+( ,"5,. *%"/%"#(3'.(" '";%.&' #("
*%",+,".(" -%",3(+(" 5,6%+.,3$&'&8 9+$/+(*
5/21/2018 PNPK TB
6/120
vi TATA LAKSANA TUBERKULOSIS
2"3("# )$)
!"#" %&'("'#") ***
+",#") -.- */
+",#") #"0&1 /*
+",#") ("20") /*
+",#") .-'(!"#"' /**
0"0 - %&'+"3414"' 1
"5 16768 09:6;6?>6< 5
@5 .6A686< 5
0"0 -- 2B+B1B(- 7
"5 %9A>86< !9C>A76;66< 705 %9
5/21/2018 PNPK TB
7/120
viiPedoman Nasional Pelayanan Kedokteran
05 Z'*;(#%"$-(5'
5/21/2018 PNPK TB
8/120
viii TATA LAKSANA TUBERKULOSIS
2"3("# ("4%5
K5K5 9%"%+(-(" I5+(5%/' GH
5/21/2018 PNPK TB
9/120
ixPedoman Nasional Pelayanan Kedokteran
2"3("# $)'1!"("'
OSR_[X1SVRV` O 6,3(" +';(*-'&'"Q '&$"'(a'#Q -'+(a'"(*'#Q %5(*6,5$3 #("
#'3("2,5.(" 1 6,3(" +';(*-'&'"Q '&$"'(a'# 7("/ #'6%+'.(" &%:(+( '"5%+*'5%" V
.(3' &%*'"//, OSR_[X1SR` O 6,3(" +';(*-'&'"Q '&$"'(a'#Q -'+(a'"(*'#Q %5(*6,5$3 #("
#'3("2,5.(" 1 6,3(" +';(*-'&'"Q '&$"'(a'#
OSR_[XbR[` O 6,3(" +';(*-'&'"Q '&$"'(a'#Q -'+(a'"(*'#Q %5(*6,5$3 #("
#'3("2,5.(" b 6,3(" '&$"'(a'#Q %5(*6,5$3
OSR_[IXUSR_[XDSR[` O 6,3(" +';(*-'&'"Q '&$"'(a'#Q -'+(a'"(*'#Q
%5(*6,5$3Q &5%+-5$*'&'" #(" #'3("2,5.(" U 6,3(" +';(*-'&'"Q '&$"'(a'#Q
-'+(a'"(*'#Q %5(*6,5$3 #(" #'3("2,5.(" D 6,3(" +';(*-'&'"Q '&$"'(a'#Q
%5(*6,5$3
b_0F[J0P"0Z;c0[5$0K& X UC_0F[J0Z;c0[5$0K&` _` b 6,3(" -'+(a'"(*'#Q
>P9M` 6(3(' .%&%4(5(" -(+, *(&7(+(.(5
>
5/21/2018 PNPK TB
10/120
x TATA LAKSANA TUBERKULOSIS
99M` -,63': -+'N(5% *'c
IPS
5/21/2018 PNPK TB
11/120
1Pedoman Nasional Pelayanan Kedokteran
4"4 )
0%'2"+656"'
!" $%&%' ()*%+%,-
+1#6 ?$/#-9 41@/%"A/-"+% F^RHJ *%3(-$+.(" #(3(* .#+5/#
7&5$12+0"0 B$,+1- CDEE 5%+#(-(5 -%+6('.(" 6%+*(."( #(3(* -%"/%"#(3'("
#%"/(" *%",+,""7( ("/.( -%"%*,(" .(&,& #(" ("/.( .%*(5'(" (.'6(5 #(3(*
#,( #%.(#% 5%+(.4'+ '"'8 !"&'#%"& &%:(+( /3$6(3 #'3(-$+.(" *%",+," #%"/(" 3(2,
OQOB -(#( 5(4," OAUA0OAUU8 ^(3(,-," #%"/(" .%*(2,(" 7("/ :,.,- 6%+(+5' '"'Q
6%6(" /3$6(3 (.'6(5 *(&'4 5%5(- 6%&(+8 G'-%+.'+(.(" -(#( 5(4," OAUU '"&'#%"&
.(&,& *%":(-(' CQ@ 2,5( F5%+*(&,. UQU 2,5( #%"/(" .$'";%.&' R!WJ #(" eeA +'6,
$+("/ *%"'"//(3 .(+%"( 8 I%:(+( /3$6(3 #'-%+.'+(.(" '"&'#%"& +%&'&5%" $6(5
(#(3(4 VQ@B .(&,& 6(+, #(" OAB .(&,& #%"/(" +'E(7(5 -%"/$6(5("8 I%.'5(+ eDB.(&,& #(" eCB .%*(5'(" (.'6(5 #' #,"'( 5%+2(#' #' "%/(+( 6%+.%*6("/8UQO
9(#( 5(4," OAUU !"#$"%&'( F#%"/(" AQVC0AQD1 2,5( .(&,&J *%"%*-(5' ,+,5(" .%%*-(5
&%5%3(4 !"#'(Q K'"(Q ?;+'.( I%3(5("8!"#$"%&'( *%+,-(.(" "%/(+( #%"/(" 6%6(" 5'"//'
-%+5(*( #' ?&'(
5/21/2018 PNPK TB
12/120
2 TATA LAKSANA TUBERKULOSIS
9(#( (E(3"7(Q -%"%+(-(" &5+(5%/' GHP9MJ #(" +,*(4 &(.'5 6('.
-%*%+'"5(4 *(,-," &E(&5(8 R(&'3 &,+N%' -+%N(3%"& 5(4," OAA1 *%3(-$+.("
6(4E( -$3( -%":(+'(" -%"/$6(5(" &%6(/'(" 6%&(+ -(&'%" .%5'.( -%+5(*( .(3' &(.'5(#(3(4 +,*(4 &(.'5 &%4'"//( *%3'6(5.(" +,*(4 &(.'5 ,"5,. *%3(.&("(.(" &5+(5%/'
GH
5/21/2018 PNPK TB
13/120
3Pedoman Nasional Pelayanan Kedokteran
*(&'4 +%"#(4Q 7('5, #' 6(E(4 DAB #%"/(" ("/.( -,5,& 6%+$6(5 *%":(-(' DAB0CDB81
F&5#"2:F1"*/-$ !"G F99MJ (#(3(4 .%5%+3'6(5(" &%3,+,4 -%"7%#'( .%&%4(5(" -,63'.
#(" &E(&5(Q ;$+*(3 #(" '";$+*(3 #(3(* -%"7%#'((" -%+(E(5(" &%&,(' #%"/("
;%-$1%/-"+%/# 8-/%6/16
5/21/2018 PNPK TB
14/120
4 TATA LAKSANA TUBERKULOSIS
I%3('" '5, 2,/( 5%+#(-(5 6%6%+(-( -%"%3'5'(" 3('" 7("/ *%"7(5(.(" 6(4E( -,5,&
$6(5 6%+4,6,"/(" #%"/(" &5(5,& -%+.(E'"("Q 2(+(. +,*(4 .% 5%*-(5 -%"/$6(5("
FSIJQ -%"/4(&'3("Q %;%. &(*-'"/ -%"/$6(5("Q 5'"/.(5 -%"#'#'.("Q -%"7(.'5 -%"7%+5(
FGMQ 4%-(5'5'&Q 5,*$+ -(+,Q #33JQ &,*6%+ 6'(7( -%"/$6(5("Q 2%"'& -%"/$6(5(" 7("/
#'/,"(.(" #(" -%"/(E(& *%"%3(" $6(5 F9MHJ8eQUA
9%3(5'4(" GH(+(5Q GP! T(.(+5(Q T$/7(.(+5(Q T(E( >(+(5Q
T(E(
5/21/2018 PNPK TB
15/120
5Pedoman Nasional Pelayanan Kedokteran
4" .565%,
U8
5/21/2018 PNPK TB
16/120
6 TATA LAKSANA TUBERKULOSIS
b8 9'"'#'7(-(54'+(/% TQ I%"(+(5"% Q ^':.+%*(&'"/4% S8 9+%N(3%":% ("# -+%#':5$+& $; #%;(,35 E'54
5,6%+:,3$&'& 5+%(5*%"5 '" I+'3(".(8 I$,54%(&5 ?&'(" T %+'5( P%#$.5%+(" M(&7(+(.(58 OAAefOD`UU@0OV8
UA8 K4("0]%,"/ MQ =$%+52$2$ PQ Z%,"/ KKQ K4(" IZQ
5/21/2018 PNPK TB
17/120
7Pedoman Nasional Pelayanan Kedokteran
4"4 ))
&%(K2K5K1)
!" 0),)*525'%, ;52&%+%
9%"%3,&,+(" .%-,&5(.((" #'3(.,.(" &%:(+( *(",(3 #(" &%:(+( %3%.5+$"'.Q .(5( .,":'
7("/ #'/,"(.(" 7('5, &5()'2?!"#$%'%(? [email protected]? A8.78
4" .)*%%3 +'>&>2
I%5'(- 6,.5' '3*'(4 7("/ #'-%+$3%4 #'3(.,.(" 5%3((4 .+'5'& $3%4 -(.(+ #(3(* 6'#("/
!3*, 9,3*$"$3$/'Q 9%"7(.'5 G(3(*Q ?"(.Q >%#(4 H+5$-%#'Q >%#(4 G'/%&5';Q P,3'5Q
P%6'#("("Q =%,+$3$/'Q L+$3$/'8
7" 0)'>,-+%& (5+&>
Z%N%3 $*"6$%2$ 7("/ #'/,"(.(" (#(3(4` Z%N%3 ! ` *%5(("(3'&'&Q ,2' .3'"'& 6%&(+ #%"/(" +("#$*'&(&'
Z%N%3 !! ` ,2' .3'"'& 3%6'4 .%:'3 X 5'#(. #'+("#$*'&(&'
Z%N%3 !!! ` -%"%3'5'(" +%5+$&-%.5';Q $6&%+N(&'$"(3
Z%N%3 !W ` &%+'(3 .(&,&Q 3(-$+(" .(&,&Q .$"&%"&,&Q -%"#(-(5 (43'
9" 9)'%6%& ')+=1),B%2>
>%+#(&(+.(" -%+'"/.(5 #' (5(& #(-(5 #'6,(5 +%.$*%"#(&' &%6(/(' 6%+'.,5`
S%.$*%"#(&' ? 6'3( 6%+#(&(+ -(#( 6,.5' 3%N%3 !
S%.$*%"#(&' > 6'3( 6%+#(&(+ -(#( 6,.5' 3%N%3 !!
S%.$*%"#(&' K 6'3( 6%+#(&(+ -(#( 6,.5' 3%N%3 !!!
S%.$*%"#(&' G 6'3( 6%+#(&(+ -(#( 6,.5' 3%N%3 !W
5/21/2018 PNPK TB
18/120
8 TATA LAKSANA TUBERKULOSIS
4"4 )))
0#K1#"& '"$)K'"5 0%'1%'2"5)"'
(64%#!65K$)$
!" $%&%' ()*%+%,-
9%"/%"#(3'(" 5,6%+.,3$&'& FJ #' !"#$"%&'( &,#(4 6%+3("/&,"/ &%2(. a(*("
-%"2(2(4(" >%3("#( "(*," 5%+6(5(& -(#( .%3$*-$. 5%+5%"5,8 I%5%3(4 -%+("/
.%*%+#%.(("Q #'5("//,3("/' *%3(3,' >(3(' 9%"/$6(5(" 9%"7(.'5 9(+,
F>91J8 I%2(. 5(4," Uebe -%"/%"#(3'(" #'3(.,.(" &%:(+( "(&'$"(3 *%3(3,' 9,&.%&*(&8H6(5 ("5' 5,6%+:,3$&'& FH?
5/21/2018 PNPK TB
19/120
9Pedoman Nasional Pelayanan Kedokteran
9(#( 5(4," OAAeQ -+%N(3%"& R!W -(#( .%3$*-$. #' !"#$"%&'( (#(3(4 &%.'5(+
OQCB8
9+%N(3%"& +%&'&5%" H?< /("#( F'-"61&@ 1$0"0-/%2$j MGSJ #' ("5(+( .(&,&
6(+, (#(3(4 &%6%&(+ OBQ #(" #' ("5(+( .(&,& -%"/$6(5(" ,3("/ (#(3(4 &%6%&(+
UOBQ &%&,(' 3(-$+(" ^RH 5(4," OAUO8C
9(#( 5(4," UeeDQ 4(&'3 I,+N%' P%&%4(5(" S,*(4
5/21/2018 PNPK TB
20/120
10 TATA LAKSANA TUBERKULOSIS
AA" .565%, B%, 8%2%'%,
.565%,
M%",+,".(" ("/.( .%&(.'5(" #(" .%*(5'(" (.'6(5 #(3(* +("/.( -%":(-('("
5,2,(" -%*6("/,"(" .%&%4(5(" ,"5,. *%"'"/.(5.(" #%+(2(5 .%&%4(5("
*(&7(+(.(58U
8%2%'%,
I(&(+(" &5+(5%/' "(&'$"(3 -%"/%"#(3'(" '"' *%"/(:, -(#( +%":("( &5+(5%/'&
P%*%"5%+'(" P%&%4(5(" #(+' OAAe &(*-(' #%"/(" 5(4," OAU1 7('5, *%",+,".("
-+%N(3%"& #(+' OVD -%+ UAA8AAA -%"#,#,. *%"2(#' OO1 -%+ UAA8AAA -%"#,#,.8
I(&(+(" 3,(+(" (#(3(4`FFUJ *%"'"/.(5.(" -%+&%"5(&% .(&,& 6(+, -(+, F>
5/21/2018 PNPK TB
21/120
11Pedoman Nasional Pelayanan Kedokteran
C" LL =$ VO 54 OAA1 5%"5("/ 9%*%+'"5(4 #(%+(4`
m (*("#%*%" LLG Ue1D 9(&(3 U@ #(" 9(&(3 UCQ '&5'3(4 6(., 7("/ #'-(.('
(#(3(4 k,+,&(" -%*%+'"5(4("l 6,.(" k.%E%"("/("l
I%6(/(' 3("#(&(" (5(, (&-%. 3%/(3 -%"7%3%"//(+((" -%"("//,3("/("
"(&'$"(3 (#(3(4`/
(8 P%-*%".%& =$ Vb1XM%".%&XIPXWXOAAe 5("//(3 UV M%' OAAe
5%"5("/ 9%#$*(" =(&'$"(3 9%"("//,3("/("
68 IP M%".%& S! =$*$+ UVXOAUV 5%"5("/ 9%#$*(" M("(2%*%"
5/21/2018 PNPK TB
22/120
12 TATA LAKSANA TUBERKULOSIS
#(" %N(3,(&' &%+5( *%"2(*'" .%5%+&%#'((" &,*6%+ #(7( F#("(Q 5%"(/(Q &(+("(
#(" -+(&(+("(J8
68 9%"/%"#(3'(" #'3(.&("(.(" #%"/(" *%"//,"(.(" &5+(5%/' GH
5/21/2018 PNPK TB
23/120
13Pedoman Nasional Pelayanan Kedokteran
%" M%*-%+3,(& #(" *%"'"/.(5.(" -%3(7("(" GH'*6'"/(" 5%."'&
! 9%*("5(-(" *,5, 3(6$+(5$+',*
! 9%"/%3$3((" 3$/'&5'.
9%*("5(,(" #(" [N(3,(&'
NG P%/'(5(" 9%","2("/`
9+$*$&'
P%*'5+(("
9%"%3'5'("
5/21/2018 PNPK TB
24/120
14 TATA LAKSANA TUBERKULOSIS
HG P$3(6$+(&' X?;M#' !"#$"%&'(Q *%3'-,5'`
M%*6%"5,. *%.("'&*% .$3(6$+(&'
M%",+,".(" 6%6(" -(#( HGR? #("
M%",+,".(" 6%6(" R!W -(#( -(&'%" 8
J" H+/("'&(&' 9%3(.&("(("
?&-%. *("(2%*%" -+$/+(*`/
(8
5/21/2018 PNPK TB
25/120
15Pedoman Nasional Pelayanan Kedokteran
G'3(.&("(.(" $3%4 9,&.%&*(&Q S,*(4 I(.'5Q >X>P9MQ P3'"'. 9%"/$6(5(" #(" G9I8
(8 9,&.%&*(&
G(3(* -%3(.&("((" #' 9,&.%&*(&Q #'6%"5,. P%3$*-$. 9,&.%&*(& 9%3(.&("(
FP99J 7("/ 5%+#'+' (5(& 9,&.%&*(& S,2,.(" M'.+$&.$-'& F9SMJQ #%"/("
#'#,.,"/ $3%4 .,+("/ 3%6'4 D F3'*(J 9,&.%&*(& I(5%3'5 F9IJ8 9(#( .%(#(("
#'3%"/.(-' 5%"(/( #(" ;(&'3'5(& -%*%+'.&((" &-,5,* >
5/21/2018 PNPK TB
26/120
16 TATA LAKSANA TUBERKULOSIS
-(+, >
5/21/2018 PNPK TB
27/120
17Pedoman Nasional Pelayanan Kedokteran
4"4 )N
(64%#!65K$)$ 0"#6
.)'2%,-+% ;%2>), .4(#(3(4 &%&%$+("/ 7("/ *%*-,"7(' .%3,4(" (5(, /%2(3( .3'"'&
*%"#,.,"/ F &%6%3,*"7( #'.%"(3 &%6(/(' &,&-%. J
?#(3(4 &%$+("/ -(&'%" 7("/ 4(&'3 -%*%+'.&((" &%#'((" 6'$3$/'"7( -$&'5';
#%"/(" -%*%+'.&((" *'.+$&.$-'&Q 6'(.(" (5(, #'(/"$&5'. :%-(5 7("/ #'(.,' $3%4
#':(5(5 5("-( *%*("#("/ (-(.(4 -%"/$6(5(" &,#(4 #'*,3(' (5(,.(4 6%3,*8
5/21/2018 PNPK TB
28/120
18 TATA LAKSANA TUBERKULOSIS
0 Y,"( *%"/4'"#(+' 5%+2(#'"7( $N%+ #'(/"$&'& #(" &'5,(&' 7("/ *%+,/'.("
-(&'%"Q -%*6%+'(" -%"/$6(5(" 6%+#(&(+.(" #'(/"$&'& .3'"'& 4("7(
#'("2,+.(" -(#( -(&'%" #%"/(" #%"/(" -%+5'*6("/(" &%6(/(' 6%+'.,5 `
P%3,4("Q /%2(3( #(" .$"#'&' .3'"'& &("/(5 .,(5 *%"#,.,"/ P$"#'&' -(&'%" -%+3, &%/%+( #'6%+'.(" -%"/$6(5(" *'&(3 ` -(#(
*%"'"/%"Q *'3'%+Q -(&'%" #%"/(" R!W -$&'5'; #&68
5/21/2018 PNPK TB
29/120
19Pedoman Nasional Pelayanan Kedokteran
-(+,8
" .4 )+2&'%;%'5 (#(3(4 .(&,& 7("/ *%3'6(5.(" $+/(" #' 3,(+ -(+%".'*
-(+, &%-%+5' -3%,+(Q .%3%"2(+ /%5(4 6%"'"/Q (6#$*%"Q &(3,+(" /%"'5$,+'"(+'(Q.,3'5Q &%"#' #(" 5,3("/Q &%3(-,5 $5(.8 P(&,& %.&5+(-(+, #(-(5 #'5%/(..("
&%:(+( .3'"'& (5(, 4'&5$3$/'& &%5%3(4 #',-(7(.(" &%*(.&'*(3 *,"/.'" #%"/("
/?C
G%252 (%'5(#(3(4 -(&'%" 7("/ 6%3,* -%+"(4 *%"#(-(5 H?< &%6%3,*"7( (5(,
+'E(7(5 *%"#(-(5.(" H?< .,+("/ #(+' U 6,3("8
2)()*51,K% (#(3(4 -(&'%" 7("/ -%+"(4
6%+#(&(+.(" 4(&'3 -%"/$6(5(" 5%+(.4'+ &%6(/(' 6%+'.,5`
! G%252 +%1(53(#(3(4 -(&'%" 7("/ &%6%3,*"7( -%+"(4 *%"#(-(5.(" H?B%+ B%;%& B>*%
5/21/2018 PNPK TB
30/120
20 TATA LAKSANA TUBERKULOSIS
5'#(. #'.%5(4,' (5(, 5'#(. #'#$.,*%"5(&'.("8
! 0%2>), ;>,B%3 (#(3(4 -(&'%" 7("/ #'-'"#(4 #(+' +%/'&5%+ F AVJ 3('"
+%N'&' /,'#%3'"% ^RH 5(4," OAUVJ8
!
(#(3(4-(&'%" 7("/ 5'#(. #(-(5 #'*(&,..(" #(3(* &(3(4 &(5, .(5%/$+' #' (5(&8
+%&'&5%" $6(58 I%6%3,* #'*,3(' -%"/$6(5(" &%6('."7( #'3(.,.(" -%*%+'.&((" 6'(.("
&-%&'*%" #(" ,2' +%&'&5%"&' $6(5 (5(, *%5$#% #'(/"$&5'. :%-(5 7("/ 5%3(4 #'&%5,2,'
^RH Fd-%+5 MXS!\J ,"5,. &%*,( -(&'%" #%"/(" +'E(7(5 -%*(.('(" H?
5/21/2018 PNPK TB
31/120
21Pedoman Nasional Pelayanan Kedokteran
" 5%+#(-(5 6,.5' .,(5 6%+#(&(+.(" 3(6$+(5$+',* (5(, *("';%&5(&' .3'"'&f
?
5/21/2018 PNPK TB
32/120
22 TATA LAKSANA TUBERKULOSIS
I%*,( -(&'%" F#%E(&(Q +%*(2(Q #(" ("(. 7("/ #(-(5 *%"/%3,(+.(" #(4(.J 7("/ #':,+'/('
-(+, &%6('."7( *%"/'+'*.(" #,( &-%&'*%" #(4(. ,"5,. -%*%+'.&((" *'.+$&.$-'. .%
3(6$+(5$+',* 7("/ 5%+2(*'" .,(3'5(&"7(8 >'3( *,"/.'" #'-%+$3%4 -(3'"/ &%#'.'5 &(5, &-%&'*%"
-(/' .(+%"( *%*'3'.' 4(&'3 7("/ 5%+6('.8
I%*,( $+("/ #%"/(" 5%*,(" ;$5$ 5$+(.& 5%+&("/.( &%6('."7( *%"/'+'*.(" &-%&'*%"
#(4(. ,"5,. -%*%+'.&((" *'.+$6'$3$/'8
)*+'$+, : $+' ; /'*%,'+*#0'+& )*+'$+,$( 10, 2"3%,4"&0(#( 5+,%
4" 9>%-,=2>2 &5()'+5*=2>2
G'(/"$&'& #'5%/(..(" 6%+#(&(+.(" 5%+#(-(5"7( -(3'"/ &%#'.'5 &(5, &-%&'*%"
!Q -&5$12+0"0 (5(, &%&,(' #%"/(" /(*6(+(" 4'&5$3$/' (5(, 6,.5'
.3'"'& &%&,(' 8
^RH *%+%.$*%"#(&' -%*%+'.&((" ,2' +%&'&5%"&' +';(*-'&'" #(" X (5(, '&$"'(a'#
5%+4(#(- .%3$*-$. -(&'%" 6%+'.,5 '"' -(#( &((5 *,3(' -%"/$6(5("`
I%*,( -(&'%" #%"/(" +'E(7(5 H?
5/21/2018 PNPK TB
33/120
23Pedoman Nasional Pelayanan Kedokteran
E)&=B) +=,L),2>=,%* 56> ')2>2&),2> =(%&
!Q
-&5$12+0"0:(+( :%-(5 #'6("#'"/.(" *%#'( -(#(5 &(2(8 M%5$#% :('+ 3%6'4 &%"&'5';
*%"#%5%.&' *'.$6(.5%+',* #(" *%"'"/.(5.(" -%"%*,(" .(&,& &%6%&(+ UAB
#'6("#'"/.(" *%#'( -(#(5 #' &(*-'"/ 3%6'4 :%-(5 *%*-%+$3%4 4(&'3 &%.'5(+ UA 4(+'
#'6("#'"/.(" OC01O 4(+' #%"/(" *%#'( -(#(58D
E)&=B) ')2>2&),2> =(%& M56> B>%-,=2&>+ 1=*)+5*%'
5/21/2018 PNPK TB
34/120
24 TATA LAKSANA TUBERKULOSIS
O%1(%' H"/"?3/$+'5*% #'(/"$&'& -(+, -(#( #%E(&(
Suspek TB
Sputum mikroskopia (BTA)
BTA (+) BTA (-)
Kasus definitif TB BTA (+) Lihat klinis dan foto toraks
Tidak sesuai TB Sesuai TB
Antibiotik 2 minggu Kasus TB BTA (-)
Perbaikan
Bukan TB
Tidak perbaikan, klinis sesuai TB
Obati sesuai kasus TB BTA (-)serta melakukan pemeriksaan
biakan sputum M.tb
Foto toraks
5/21/2018 PNPK TB
35/120
25Pedoman Nasional Pelayanan Kedokteran
7" 0),-=(%&%, &5()'+5*=2>2 ;%'5
+1#6 ?$/#-9 41@/%"A/-"+%*%+%.$*%"#(&'.(" $6(5 .$*6'"(&' #$&'& 5%5(- FPG>Q
VC0D1 ./ >>Q DD0@A ./ >> #(" 3%6'4 #(+' @A ./ >>8e
.%()* H"/" G$&'& +%.$*%"#(&' H?< 3'"' -%+5(*( ,"5,. #%E(&(
H?>J
M(.&'*,*
F*/J
G$&'&
F*/X./>>J
M(.&'*,*
F*/J
!&$"'(a'# D F10bJ VAA UA FC0UOJ eAA
S';(*-'&'" UA FC0UOJ bAA UA FC0UOJ bAA
9'+(a'"(*'# OD FOA0VAJ 0 VD FVA01AJ 0
[5(*6,5$3 UD FUD0OAJ 0 VA FOD0VDJ 0
I5+%-5$*'&'"q UD FUO0UCJ UD FUO0UCJ UAAA
q9(&'%" 6%+,&'( #' (5(& bA 5(4," 5'#(. #(-(5 *%"5$3%+("&' 3%6'4 #(+' DAA0@AA */ -%+ 4(+'Q 6%6%+(-( -%#$*(" *%+%.$*%"#(&'.("
#$&'& UA */X./ >> -(#( -(&'%" .%3$*-$. ,&'( '"'8 9(&'%" #%"/(" 6%+(5 6(#(" #' 6(E(4 DA ./ 5'#(. #(-(5 *%"5$3%+("&' #$&'&
3%6'4 #(+' DAA0@DA */ -%+ 4(+'8
G'.,5'- #(+' FOJ
5/21/2018 PNPK TB
36/120
26 TATA LAKSANA TUBERKULOSIS
I%*,( -(&'%" F5%+*(&,. *%+%.( 7("/ 5%+'";%.&' R!WJ 7("/ 6%3,* -%+"(4 #'$6(5' 4(+,& #'6%+'
-(#,(" $6(5 7("/ #'&%-(.(5' &%:(+( '"5%+"(&'$"(3 *%"//,"(.(" $6(5 7("/ 6'$(N('3(6'3'5(&"7(
5%3(4 #'.%5(4,'8 \(&% '"'&'(3 &%4(+,&"7( 5%+#'+' (5(& '&$"'(a'#Q +';(*-'&'"Q -'+(a'"(*'#Q #("
%5(*6,5$38 \(&% 3("2,5(" &%4(+,&"7( 5%+#'+' (5(& '&$"'(a'# #(" +';(*-'&'" 7("/ #'6%+'.(" &%3(*(
1 6,3("8 G$&'& $6(5 ("5' 7("/ #'/,"(.(" 4(+,& &%&,(' #%"/(" +%.$*%"#(&' '"5%+"(&'$"(38
P$*6'"(&' #$&'& 5%5(- 7("/ 5%+#'+' (5(& .$*6'"(&' O $6(5 F'&$"'(a'#JQ V $6(5 F'&$"'(a'#Q
+';(*-'&'"Q #(" -'+(a'"(*'#JQ #(" 1 $6(5 F'&$"'(a'#Q +';(*-'&'"Q -'+(a'"(*'#Q #(" %5(*6,5$3J
&("/(5 #'+%.$*%"#(&'.("8
)*+'$+, < /'*%,'+*#0'+& )*+'$+,$( 10, 2"3%,4"&0(#( 5+,%
0%B5%, =(%& 2&%,B%' 5,&5+ ;%2>), B),-%, +%252 (%'5
9(&'%" #%"/(" .(&,& 6(+, #'(&,*&'.(" -%.( 5%+4(#(- H?< .%:,(3'`O
! 5'"//(3 #' #(%+(4 #%"/(" -+%N(3%"& 5'"//' +%&'&5%" '&$"'(a'#
?
5/21/2018 PNPK TB
37/120
27Pedoman Nasional Pelayanan Kedokteran
.%()* H"C" 0%B5%, =(%& 2&%,B%' ;%2>), .4 +%252 (%'5 MB),-%, %2512> %&%5
B>+)&%35> ;)+% @!.N
\(&% '"5%"&'; \(&% 3("2,5("
SR_[ O 6,3(" SR 1 6,3("
G'.,5'- #(+' FOJ
>%+#(&(+.(" 4(&'3 -%"%3'5'(" *%5(("(3'&'& *(.( ^RH *%+%.$*%"#(&'.(" -(#,(" &5("#(+
,"5,. -(+, .(&,& 6(+, (#(3(4 OSR_[X1SR
P)+=1),B%2> !
9(#,(" (35%+"(5'; OSR_[X1SVR
V4(+,& #'&%+5(' -%"/(E(&(" .%5(5 &%:(+( 3("/&,"/ ,"5,. &%5'(-
#$&'& $6(58P)+=1),B%2> 4
.#+5/# F#/% -+ 8-+, 7J CDDS:CDET *%":("("/.(" 5(+/%5 ,"5,. &%*,( -(&'%" #%"/("
+'E(7(5 -%"/$6(5(" H?< 4(+,& #'-%+'.&( ,2' +%&'&5%"&' H?< -(#( (E(3 -%"/$6(5("8
L2' +%&'&5%"&' $6(5 #'3(.,.(" &%#'.'5"7( ,"5,. '&$"'(a'# #(" +';(*-'&'" #(" 5,2,(""7(
-%"/$6(5(" 7("/ 5%-(58OQUO
T%"'& -%"/$6(5(" H?< ,3("/ 6%+/("5,"/ -(#( .(-(&'5(& 3(6$+(5$+',* #(%+(4
&%5%*-(58 >'3( 5%+#(-(5 3(6$+(5$+',* 7("/ #(-(5 *%3(.,.(" ,2' +%&'&5%"&' $6(5
6%+#(&(+.(" ,2' *$3%.,3(+ :%-(5 #(" *%"#(-(5.(" 4(&'3 #(3(* U0O 4(+' *(.( 4(&'3
'"' #'/,"(.(" ,"5,. *%"%"5,.(" -(#,(" H?< -(&'%"8UV >'3( 3(6$+(5$+',* 4("7(
#(-(5 *%3(.,.(" ,2' +%&'&5%"&' $6(5 .$"N%"&'$"(3 #%"/(" *%#'( :('+ (5(, -(#(5
#(" *%"#(-(+.(" 4(&'3 #(3(* 6%6%+(-( *'"//, (5(, 6,3(" *(.( #(%+(4 5%+&%6,5
&%6('."7( *%"//,"(.(" -(#,(" %*-'+'& &(*6'3 *%","//, 4(&'3 ,2' +%&'&5%"&' $6(58O
9(&'%" #%"/(" .(&,& &%-%+5' '"' #(-(5 *%"%+'*( .%*6(3' -(#,(" H?< 3'"' -%+5(*(
FOSR_[IXUSR_[XDSR[J8OQU19%+3, #':(5(5 6(4E( -%"/$6(5(" ,3("/ #%"/(" -(#,("
H?< 3'"' -%+5(*( '"' 5'#(. #'#,.,"/ $3%4 6,.5' ,2' .3'"'&8 M%5$#% '"' #'#%&('" ,"5,.
#'/,"(.(" -(#( #(%+(4 #%"/(" -+%N(3%"& +%"#(4 +%&'&5%" $6(5 -+'*%+ #(" 6(/'
5/21/2018 PNPK TB
38/120
28 TATA LAKSANA TUBERKULOSIS
-(&'%" 7("/ &%6%3,*"7( #'$6(5' #%"/(" -(#,(" 7("/ *%"/("#,"/ +';(*-'&'" -(#(
;(&% O 6,3(" -%+5(*(8UD
9%"'3('(" .%*,"/.'"(" +%&'&5%"&' $6(5Q 6%+#(&(+.(" +'E(7(5 -%"/$6(5(" 5%+#(4,3,Q -(2("("
#%"/(" &,*6%+ 7("/ *,"/.'" +%&'&5%" $6(5Q #(" -+%N(3%"& +%&'&5%"&' $6(5 #(3(* *(&7(+(.(5&%4(+,&"7( #'3(.,.(" -(#( &%*,( -(&'%"8 L2' +%&'&5%"&' $6(5 &%4(+,&"7( #'3(.,.(" -(#( (E(3
-%"/$6(5(" ,"5,. &%*,( -(&'%" 7("/ &%6%3,*"7( -%+"(4 #'$6(5'8 9(&'%" 7("/ (-,& #(4(. 5%5(-
-$&'5'; &%5%3(4 -%"/$6(5(" 5'/( 6,3(" &%3%&(' #(" -(&'%" /(/(3 -%"/$6(5("Q -,5,& $6(5Q (5(, .(&,&
.(*6,4 &%5%3(4 -%"/$6(5(" 4(+,& &%3(3, #'"'3(' 5%+4(#(- +%&'&5%"&' $6(58 L"5,. -(&'%" #%"/("
.%*,"/.'"(" +%&'&5%"&' $6(5Q 6'(.(" #(" ,2' &%"&'5'N'5(&X+%&'&5%"&' $6(5 &%5'#(."7( 5%+4(#(-
'&$"'(a'# #(" +';(*-'&'" &%4(+,&"7( #'3(.&("(.(" &%/%+( ,"5,. *%*'"'*(3.(" .%*,"/.'"("
-%",3(+("8 K(+(0:(+( -%"/$"5+$3(" '";%.&' 7("/ *%*(#(' &%4(+,&"7( #'3(.,.("8
)*+'$+, .. /'*%,'+*#0'+& )*+'$+,$( 10, 2"3%,4"&0(#( 5+,%
0)1%,&%5%, ')2;=,2 ;),-=(%&%,
I%*,( -(&'%" 4(+,& #'-("5(, ,"5,. *%"'3(' +%&-$"& 5%+(-'8 9%*("5(,(" 7("/ +%/,3(+
5'#(. #''"/'".("8 I%*,( -(&'%"Q 9MH #(" 5%"(/( .%&%4(5(" &%6('."7( #'*'"5( ,"5,.
*%3(-$+.(" /%2(3( 7("/ *%"%5(- (5(, *,":,3 .%*6(3'Q /%2(3( %;%. &(*-'"/ H?%+(5 6(#(" -(&'%" 4(+,& #'-("5(, &%5'(- 6,3(" #(" #$&'& H?< #'&%&,('.(" #%"/("
-%+,6(4(" 6%+(5 6(#("8 S%&-$"& -%"/$6(5(" -(+, #'-("5(, #%"/(" (-,&(" #(4(.
>
5/21/2018 PNPK TB
39/120
29Pedoman Nasional Pelayanan Kedokteran
?-,&(" #(4(. >
5/21/2018 PNPK TB
40/120
30 TATA LAKSANA TUBERKULOSIS
9(#( #(%+(4 7("/ 5'#(. *%*'3'.' .(-(&'5(& 3(6$+(5$+',* ,"5,. 6'(.(" #(" ,2'
+%&'&5%"&' $6(5 *(.( -%*("5(,(" 5(*6(4(" #%"/(" (-,&(" #(4(. >
5/21/2018 PNPK TB
41/120
31Pedoman Nasional Pelayanan Kedokteran
;),-=(%&%, 2)()*51,K%
9(#( -(&'%" #%"/(" +'E(7(5 -%"/$6(5(" &%6%3,*"7( 6'3( &-%&'*%" 7("/ #'-%+$3%4
-(#( (.4'+ ;(&% '"5%"&'; F6,3(" .%5'/(J (#(3(4 >
5/21/2018 PNPK TB
42/120
32 TATA LAKSANA TUBERKULOSIS
.%()* H"F"
I%*6,4
-%"/$6(5(" #(" (-,&(" #(4(. >
5/21/2018 PNPK TB
43/120
33Pedoman Nasional Pelayanan Kedokteran
TB Paru
TB Paru Kasus Baru TB Paru Kasus Pengobatan Ulang
OAT Kategori I OAT Kategori II, bila terdapat hasil biakansputum M.Tb dan uji kepekaan obat maka
terapi disesuaikan
O%1(%' H"C8 ?3/$+'5*% -%"/$6(5(" -(+, -(#( #%E(&(8
Q:)+ @!. K%,- &>B%+ B>>,->,+%,
I%6(/'(" 6%&(+ -(&'%" #(-(5 *%"7%3%&('.(" -%"/$6(5(" 5("-( .%2(#'(" 5'#(.
#''"/'".(" 7("/ 6%+*(."( "(*," &%6(/'(" .%:'3 #(-(5 *%"/(3(*'"7(8 P(+%"( '5,
-%"5'"/ *%*("5(, .3'"'& -(&'%" &%3(*( -%"/$6(5(" &%4'"//( %;%. 5'#(. #''"/'".("
#(-(5 #'#%5%.&' &%/%+( #(" #'5(5( 3(.&("( #%"/(" 5%-(58 9(&'%" 7("/ &%4(5 #(-(5
*%":%/(4 %;%. &(*-'"/ '"#,.&' $6(58 =%,+$-(5' -%+';%+ &%-%+5' .%6(& (5(, +(&(
&%-%+5' 5%+6(.(+ -(#( 5("/(" (5(, .(.' &%+'"/ 5%+2(#' -(#( -%+%*-,(" 4(*'3Q '";%.&'
R!WQ -%"7(3(4/,"((" (3.$4$3Q *(3",5+'&'Q #'(6%5%&Q -%"7(.'5 4(5' .+$"'.Q /(/(3
/'"2(38O9(#( -(&'%" &%-%+5' '"' &%6('."7( #'6%+'.(" -%"/$6(5(" -%":%/(4(" #%"/("
-'+'#$.&'" OD */X 4(+' 6%+&(*( #%"/(" H?
5/21/2018 PNPK TB
44/120
34 TATA LAKSANA TUBERKULOSIS
.%()* H"H" 9%"#%.(5(" 6%+#(&(+.(" /%2(3( ,"5,. *%"/$6(5' %;%. 5'#(. #''"/'".(" H?B%+ B>>,->,+%, MQ.9N G)15,-+>,%,
=(%& ;),K)(%( 0),-=(%&%,
!/3+1?$%-"U/% +5/- ,$%3$5/5 6/% 1&V&U
U$,/6/ 6+U-$1 /9#" 0$@$1/
S,(* .,3'5 #%"/(" (5(, 5("-( /(5(3 I5%+-5$*'&'"Q'&$"'(a'#Q
+';(*-'&'"Q
-'+(a'"(*'#
R%"5'.(" H?2 ')2>2&), =(%&
!Q -&5$12+0"07('5,`U
M$"$+%&'&5%"` '&$3(5!Q -&5$12+0"0.%6(3 5%+4(#(- &(3(4 &(5, H?< 3'"' -%+5(*(8
9$3'+%&'&5%"` '&$3(5!Q -&5$12+0"0.%6(3 #,( (5(, 3%6'4 H?< 3'"' -%+5(*( &%3('"
.$*6'"(&' +';(*-'&'" #(" '&$"'(a'#8
S%&'&5%" $6(5 /("#( (5(, #'.%"(3 #%"/(" '-"61&@:1$0"0-/%- -&5$12+0"0 FMGS0
J` '&$3(5 !Q -&5$12+0"0+%&'&5%" *'"'*(3 5%+4(#(- '&$"'(a'# ("# +';(*-'&'"
7('5, H?< 7("/ -(3'"/ .,(5 #%"/(" (5(, 5("-( #'&%+5(' +%&'&5%" 5%+4(#(- H?'(&("7( -(#,(" -%"/$6(5(" %*-'+'& (.(" #'&%&,('.("
&%5%3(4 (#( 4(&'3 ,2' +%&'&5%"&' $6(5 '"#'N'#,(38
9%"/$6(5(" -(#,(" '"#'N'#,(38 9(#,(" -%"/$6(5(" 6%+#(&(+.(" +'E(7(5
-%"/$6(5(" &%6%3,*"7( #(" 4(&'3 ,2' +%&'&5%"&' -(&'%" 6%+&("/.,5("8
9(#,(" $6(5 &5("#(+ +%&'&5%" $6(5 /("#( #' !"#$"%&'( (#(3(4 *'"'*(3 b 6,3("
%5'$"(*'#Q &'.3$&%+'" #(" #'3("2,5.(" UC 6,3(" ;(&% 3("2,5(" #%"/(" -(#,(" $6(5
K& X UC_0F[J0Z;c0[5$0K&J8 [5(*6,5$3 #(" -'+(a'"(*'# #(-(5 #'6%+'.(" "(*," 5'#(.
5%+*(&,. $6(5 -(#,(" &5("#(+Q 6'3( 5%3(4 5%+6,.5' +%&'&5%" *(.( %5(*6,5$3 5'#(.
#'6%+'.("8UeQOA
9%"/$6(5(" +%&'&5%" $6(5 /("#( #'6(/' *%"2(#' #,( ;(&% 7('5, ;(&% '"5%"&'; #("
3("2,5("8 Z(*( ;(&% '"5%"&'; -(#,(" &5("#(+ !"#$"%&'( (#(3(4 6%+#(&(+.(" .$"N%+&'
6'(.("8 H6(5 &,"5'. #'6%+'.(" &%3(*( ;(&% '"5%"&'; #'5%+,&.(" &%.,+("/0.,+("/"7(
b 6,3(" (5(, *'"'*(3 1 6,3(" &%5%3(4 .$"N%+&' 6'(.("8 =(*," +%.$*%"#(&' ^RH
5(4," OAUU *%"7%6,5.(" ;(&% '"5%"&'; 7("/ #'+%.$*%"#(&'.(" -(3'"/ &%#'.'5 C 6,3("8
9%"#%.(5(" '"#'N'#,(3 5%+*(&,. 4(&'3 6'(.("Q (-,&(" #(4(. >
5/21/2018 PNPK TB
49/120
39Pedoman Nasional Pelayanan Kedokteran
6'(.("8 =(*," ^RH 5(4," OAUU *%+%.$*%"#(&'.(" 5$5(3 3(*("7( -%"/$6(5("
(#(3(4 -(3'"/ &%#'.'5 OA 6,3("8OQUe
9%:&%' ;52&%+%
U8
Y%"%N(` ^RH 9+%&&f OAUA8
O8 $+3# R%(354 H+/("'a(5'$"8 (+"(+# MQ ?36%+5 RQ K$%5a%% YQ Hr>+'%" SQ >$&*(" M[Q8 S(-'# *$3%:,3(+ &:+%%"'"/ ;$+
*,35'#+,/0+%&'&5("5 5,6%+:,3$&'& '" ( 4'/40N$3,*% -,63': 4%(354 3(6$+(5$+7 '" I$,54 ?;+':(8 ?* T
$; S%&-'+ ("# K+'5 K(+% M%#8 OAACfU@@`@C@0eO8
UU8 ?*%+':(" ,+*(" Q %5 (3Q8 I5("#(+#'a%# 5+%(5*%"5
$; (:5'N% 5,6%+:,3$&'& '" -(5'%"5& E'54 -+%N'$,& 5+%(5*%"5 ("#X$+ E'54 *$"$0+%&'&5(":% 5$
'&$"'(a'#` ( &7&5%*(5': +%N'%E ("# *%5(0("(37&'&8 93$I M%#':'"%8 OAAefbFeJ`%UAAAUDA8
UV8 %+/( [Q %5 (38 K(+% #,+'"/ 54%
'"5%"&'N% -4(&%` -+$*$5'$" $; (#4%+%":%8 !"5 T $;
5/21/2018 PNPK TB
50/120
40 TATA LAKSANA TUBERKULOSIS
54% 0+%3(5%# M'33%""',* G%N%3$-*%"5 Y$(3& OAAb8
Ub8 S,&%" !G !0P=Q ?3(+:$" [Q >'33$ =Q >'&&%33 PQ >$'33$5 \Q %5 (38 K$:4+("% &7&5%*(5': +%N'%E $;
#'+%:537 $6&%+N%# 54%+(-7 ;$+ 5+%(5'"/ 5,6%+:,3$&'&` /$$# ("(37&'& $; 54% E+$"/ $,5:$*%8 !"5
T$,+" $;
5/21/2018 PNPK TB
51/120
41Pedoman Nasional Pelayanan Kedokteran
4"4 N
(64%#!65K$)$ 0"2" !%"2""' !+6$6$
!" $%&'()%*+,-, .-*-'(
29
5/21/2018 PNPK TB
52/120
42 TATA LAKSANA TUBERKULOSIS
18 >,.5' *'.+$6'$3$/' #(" (5(, 4'&5$-(5$3$/' *%","2,..(" 5,6%+.,3$&'&
%9%()&)2 E)*>&52
G'(6%5%& *%3'5,& FGMJ *%+,-(.(" &(3(4 &(5, ;(.5$+ +'&'.$ 5%+&%+'"/ -(#( -(&'%"
-(+,8 I((5 '"'Q -+%N(3%"& 5%+2(#'"7( -(+, *%"'"/.(5 &%'+'"/ #%"/(" -%"'"/.(5("
-+%N(3%"& -(&'%" GM8 \+%.,%"&' GM -(#( -(&'%" #'3(-$+.(" &%.'5(+ UA0UDB #("
-+%N(3%"& -%"7(.'5 '";%.&' '"' O0D .(3' 3%6'4 5'"//' -(#( -(&'%" #'(6%5%& #'6("#'"/.("
#%"/(" .$"5+$3 7("/ "$"0#'(6%5%&8V
G'(6%5%& 6%+4,6,"/(" #%"/(" -%"'"/.(5(" +'&'.$ .%/(/(3(" #(" .%*(5'(" #(3(*
-%"/$6(5(" 5,6%+.,3$&'&8 9(&'%" #%"/(" #'(6%5%& *%3'5,& *%*-,"7(' +'&'.$ +%3(5';
/(6,"/(" .%/(/(3(" #(" .%*(5'(" &%6%&(+ UQbe F!P eDBQ UQVb0OQUOJ8 S'&'.$ +%3(5';
,"5,. .%*(5'(" #(3(* -%"/$6(5(" 5,6%+.,3$&'& &%6%&(+ UQCe F!PeDBQ UQDO0OQVbJ8
G'(6%5%& 2,/( 6%+4,6,"/(" #%"/(" -%"'"/.(5(" +'&'.$ +%3(-& #%"/(" SS VQCe F!P
eDB OQ1V0bQOVJ81
9(&'%" 0GM '";%.&'"7( 3%6'4 6%+(5 F1DB N& OOQ@BJ F-sAQAUJQ *,(5("'32+5/2-$1"/#
7("/ 3%6'4 6("7(. FOQe t UQV FtJ N& UQe t UQ@ FtJ F-sAQAUJQ 5'"/.(5 .%/(/(3("
-%"/$6(5(" 7("/ 3%6'4 5'"//' FU@B N& OBJ #(" E(.5, .$"N%+&' 7("/ 3%6'4 3(*(
OQD t V 6,3(" N& UQb t UQ1 6,3("8 I%5%3(4 U 5(4,"Q -(&'%" 0GM :%"#%+,"/ 3%6'4
6("7(. 7("/ *%"2(#' +%&'&5%"& $6(5 /("#( #'6("#'"/ "$" GM FDB N& AQC B
5/21/2018 PNPK TB
53/120
43Pedoman Nasional Pelayanan Kedokteran
-jAQADbBJ8 9(&'%" 0GM 2,/( *%"/(3(*' .%5%+3(*6(5(" -%*,3'4(" '"#%.& *(&&(
5,6,4 #(" .(#(+ 4%*$/3$6'" 7("/ *%+,-(.(" 4(3 5%+-%"5'"/ -(#( -+$&%& -%*,3'4("8DQb
9%"("/("(" 0GM 4(+,& #';$.,&.(" -(#( #'(/"$&'& (E(3Q -%"/%"#(3'(" .(#(+
/,3( #(+(4 &%+5( *$"'5$+'"/ .%5(5 .3'"'& #(" -%"/$6(5("8 G%"/(" #%*'.'(" -%+3,#'3(.,.(" &.+'"'"/ 7("/ 5%+(5,+ -(#( -(&'%" GMQ 5%+,5(*( 7("/ *%","2,..("
@
S%.$*%"#(&'-%"/$6(5(" 5,6%+.,3$&'& #%"/(" #'(6%5%& *%3'5,&`
9(#,(" H?< -(#( -+'"&'-"7( &(*( #%"/(" 5("-( GMQ #%"/(" &7(+(5 .(#(+ /,3(
#(+(4 5%+.$"5+$3
?-(6'3( .(#(+ /,3( #(+(4 5'#(. 5%+.$"5+$3Q *(.( 3(*( -%"/$6(5(" #(-(5 #'3("2,5.("&(*-(' e 6,3("
R(5'04(5' #%"/(" -%"//,"((" %5(*6,5$3Q .(+%"( %;%. &(*-'"/ %5(*6,5$3 -(#( *(5(f
&%#("/.(" -(&'%" GM &%+'"/ *%"/(3(*' .$*-3'.(&' .%3('"(" -(#( *(5(
9%+3, #'-%+4(5'.(" -%"//,"((" +';(*-'&'" .(+%"( (.(" *%"/,+("/' %;%.5'N'5(& $6(5 $+(3
("5'#'(6%5%& F&,3;$"'3 ,+%(J &%4'"//( #$&'&"7( -%+3, #'5'"/.(5.("
9%+3, -%"/(E(&(" &%&,#(4 -%"/$6(5(" &%3%&('Q ,"5,. *%"#%5%.&' #'"' 6'3( 5%+2(#'
.%.(*6,4("
)"/@%+0"0 7J ,/6/ F/0"$% ?;M
G%5%.&' #'"' 5,6%+.,3$&'& -(#( -(&'%" R!W 4(+,& #'3(.,.(" #%"/(" 5%3'5' #(" #'-%+3,.("
-%"/(3(*(" -+(.5'&'8 G'(/"$&'& -(#( -(&'%" R!W 6%+6%#( #%"/(" #'(/"$&'&
%.&5+(-(+, 3%6'4 &%+'"/ #'5%*,.(" -(#( -(&'%" #%"/(" R!W #'6("#'"/.(" -(&'%"
5("-( R!W &%4'"//( 6'3( #'5%*,.(" %.&5+(-(+, 4(+,& #'-'.'+.(" .%*,"/.'"("
'";%.&' R!W8
5/21/2018 PNPK TB
54/120
44 TATA LAKSANA TUBERKULOSIS
L2' R!W #(" .$"&%3'"/ 4(+,& #'+%.$*%"#(&'.(" -(#( &%*,( -(&'%" 7("/ *%"#%+'5( (5(,
7("/ #'#,/( *%"#%+'5( 5,6%+.,3$&'&8 9%*%+'.&((" '"' *%+,-(.(" 6(/'(" -%"5'"/ *("(2%*%"
+,5'" 6(/' &%*,( -(&'%" #' #(%+(4 #%"/(" -+%N(3%"&' '";%.&' R!W 7("/ 5'"//' #(3(* -$-,3(&'
,*,*Q -(&'%" #%"/(" /%2(3( #("X(5(, 5("#( .$"#'&' 7("/ 6%+4,6,"/(" R!W #(" -(&'%" #%"/("
+'E(7(5 +'&'.$ 5'"//' 5%+-(2(" R!W8 M%"/'"/(5 5%+#(-(5 4,6,"/(" 7("/ %+(5 ("5(+( 5,6%+.,3$&'%"/(" '";%.&' R!W -(#( #(%+(4 #%"/(" -+%N(3%"&' R!W 7("/ 5'"//' *(.( -%"#%.(5(" 7("/
5%+'"5%/+(&' #'+%.$*%"#(&'.(" ,"5,. -%":%/(4(" #(" -%"(5(3(.&("((" .%#,( '";%.&'8
8&%,B%' /H A8.7
>('. #%5%.&' #'"' -(#( -(&'%" R!W *(,-," #%5%.&' #'"' R!W -(#( -(&'%"
.%#,("7( -%"5'"/ ,"5,. *%"'"/.(5.(" -%"%*,(" #'"' .$'";%.&' 0R!W &%4'"//(
#(-(5 *%*,3(' -%"/$6(5(" 3%6'4 :%-(5 #(" .%6%+4(&'3(" -%"/$6(5(" (.(" 3%6'4 6('.8?3/$+'5*( 5(5(3(.&("( 0R!W #(-(5 #'3'4(5 -(#( /(*6(+ D8U8 R(304(3 7("/ -%+3,
#'.%5(4,' #(3(* *%"%/(..(" #'(/"$&'& -(#( -(&'%" #%"/(" R!W (#(3(4 &%6(/('
6%+'.,5`
Y(*6(+(" .3'"'&
Y(*6(+(" .3'"'& &%:(+( ,*,* #'(E(3' #%"/(" 6(5,. 3%6'4 #(+' O0V *'"//,Q
&%#("/.(" -(#( -(&'%" R!WX?!GI 6(5,. 6,.(" *%+,-(.(" /%2(3( ,*,*8
9(#( 0R!WQ #%*(* #(" -%",+,"(" 6%+(5 6(#(" *%+,-(.(" /%2(3( 7("/
-%"5'"/8
5/21/2018 PNPK TB
55/120
45Pedoman Nasional Pelayanan Kedokteran
d-%+5 MXS!\
9%"//,"(("d-%+5 MXS!\ #(3(* (3/$+'5*( #'(/"$&5'. ,"5,. -$-,3(&'
HGR? (#(3(4 2+0-:$
5/21/2018 PNPK TB
56/120
46 TATA LAKSANA TUBERKULOSIS
O%1(%' I"/"?3/$+'5*% 5(5( 3(.&("( 0R!W
?%'4%!+@+' 8+A+'+'
\(.5$+ 7("/ #(-(5 *%"'"/.(5.(" ("/.( -%",3(+(" (#(3(4 3%5(. '";%.&' F-(+,
(5(, 3(+'"/JQ &-,5,* >
5/21/2018 PNPK TB
57/120
47Pedoman Nasional Pelayanan Kedokteran
R(+,& #'2%3(&.(" -(#( -(&'%" R!W 6(4E( 5'"//(3 #' 3'"/.,"/(" 6%+'&'.$ 5'"//' ,"5,. 5%+2(#'"7(
-%",3(+(" F&%-%+5' 3'"/.,"/(" .,*,4 #(" -("5' 2$*-$J (.(" *%"'"/.(5.(" .%*,"/.'"("
5%+2(#'"7( '";%.&'!Q -&5$12+0"0
P)+=1),B%2> 4
9(#( ;(&'3'5(& .%&%4(5(" #(" 3'"/.,"/(" 6%+'&'.$ 5'"//' ,"5,. 5%+2(#'"7( -%",3(+(" Q -(&'%"
#%"/(" .%:,+'/((" '";%.&' 4(+,& #'-'&(4.(" #(+' -(&'%" 3('"Q 5%+,5(*( #(+' -(&'%" R!W
P)+=1),B%2> !
?%'!03+*+' *"3%,B"&0(#( 8+$+ 8+(#%' C/D
9(#( -+'"&'-"7( 5(5( 3(.&("( -%"/$6(5(" -(#( -(&'%" #%"/(" '";%.&' R!W &(*(
&%-%+5' -(&'%" 5("-( R!W8 H6(5 -(#( -(&'%" R!W &(*( %;%.5';"7( #%"/("
-(&'%" 5("-( R!W8 9%"/$6(5(" -(&'%" #%"/(" .$'";%.&' 0R!W 3%6'4 &,3'5 #(+'
-(#( -(#( -(&'%" 5("-( R!W8 9(&'%" 0R!W *%*-,"7(' &'&5%* '*,"'5(& 7("/
+%"#(4 #(" &%+'"/ #'5%*,.(" '";%.&' 4%-(5'5'& &%4'"//( &%+'"/ 5'*6,3 %;%. &(*-'"/
$6(5Q '"5%+(.&' ("5(+ $6(5 7("/ (.(" *%*-%+6,+,. .$"#'&' -(&'%" #(" $6(5 4(+,&
#'4%"5'.(" (5(, #'.,+("/' #$&'&"7( *(.( -%"/$6(5(" -," *%"2(#' 3%6'4 -("2("/&%+5( .%-(5,4(" -(&'%" &%+'"/ 5%+/("//,8C
I%*,( -(&'%" F5%+*(&,. 7("/ 5%+'";%.&' R!WJ 7("/ 6%3,* -%+"(4 #'$6(5' 4(+,& #'6%+'.("
-(#,(" $6(5 3'"' -%+5(*( 7("/ #'&%-(.(5' &%:(+( '"5%+"(&'$"(3 *%"//,"(.(" $6(5 7("/
6'$(N('3'6'3'5'"7( 5%3(4 #'.%5(4,'8
8&%,B%' R A8.7
! \(&% (E(3` O 6,3(" !=RQ S!\Q 9_?Q #(" [M>
! \(&% 3("2,5("` 1 6,3(" !=R #(" S!\Q (5(, b 6,3(" !=R #(" %5(*6,5$3
! 9%*6%+'(" !=R #(" [M> &%3(*( b 6,3(" ,"5,. ;(&% 3("2,5(" 5'#(. #'+%.$*%"#(&'
,"5,. -(&'%" #%"/(" R!W .(+%"( *,#(4 5%+2(#' .%/(/(3(" -%"/$6(5(" (5(,
.(*6,48
5/21/2018 PNPK TB
58/120
48 TATA LAKSANA TUBERKULOSIS
I%*,( -(&'%" #%"/(" R!W (5(, -(&'%" 7("/ 5'"//(3 #'3'"/.,"/(" #%"/(" -+%N(3%"&
R!W 5'"//'Q-%"/$6(5(" ;(&% (E(3 #(" ;(&% 3("2,5(" 4(+,& #'6%+'.(" &%5'(- 4(+'
P)+=1),B%2> !
L"5,. -(&'%" 7("/ 5'#(. *,"/.'" #'6%+'.(" &%5'(- 4(+'Q -%*6%+'(" V .(3' &%*'"//, *%+,-(.("
(35%+"(5';
P)+=1),B%2> 4
G$&'& H?< 7("/ #'6%+'.(" #'("2,+.(" ,"5,. *%"/'.,5' ("2,+(" '"5%+"(&'$"(3 #("
&("/(5 #'("2,+.(" #(3(* .$*6'"(&' #$&'& 5%5(- FPG
#'/,"(.("Q -%+(" ?SWQ 5,*-("/ 5'"#'4 %;%. &(*-'"/ $6(5Q "''&%$:1$2+%0-"-&-"+%
F!S!IJ #(" *(&(3(4 .%-(5,4(" -%"/$6(5("8
I%*,( -(&'%" 5,6%+.,3$&'& #%"/(" '";%.&' R!W &%4(+,&"7( #'%N(3,(&' ,"5,. *%"%"5,.("
-%+3,X5'#(."7( -%"/$6(5(" ("5'+%5+$N'+(3 #'6%+'.(" &%3(*( *(&( -%"/$6(5(" 5,6%+.,3$&'&8
9%+%":("((" 7("/ 5%-(5 ,"5,. *%"/(.&%& $6(5 ("5'+%5+$N'+(3 &%4(+,&"7( #'6,(5 ,"5,. -(&'%"
7("/ *%*%",4' '"#'.(&'8 >(/('*("(-," 2,/( -%3(.&("((" -%"/$6(5(" 5,6%+.,3$&'& 5'#(.6$3%4 #'5,"#(8 9(&'%" 5,6%+.,3$&'& #(" '";%.&' R!W 2,/( &%4(+,&"7( #'6%+' .$5+'*$.&(a$3
&%6(/(' -%":%/(4(" '";%.&'3('""7(8
8&%,B%' /I A8.7
9(&'%" #%"/(" '";%.&' R!W *,#(4 &%.(3' 5%+.%"( '";%.&' $-$+5,"'&5'. &%4'"//( &%*,(
-(&'%" R!W 7("/ 5%3(4 5%+#'(/"$&'& &%6(/(' &(3(4 &(5, '";%.&' $--$+5,"'&5'.
4(+,& #'6%+'.(" .$5+'*$.&(a$3 &%6(/(' -%":%/(4(" '";%.&' 3('"89(#( -,&(5 3(7("("
5/21/2018 PNPK TB
59/120
49Pedoman Nasional Pelayanan Kedokteran
#'+%.$*%"#(&'.(" ,"5,. -(&'%" #%"/(" "'3(' KG1 sOAA &%3X**V -(#( -(&'%" R!W
5("-( Q &%#("/.(" -(#( -(&'%" R!W 7("/ 5%3(4 #'#'(/"$&'& .$5+'*$.&(a$3 #(-(5
#'6%+'.(" 3("/&,"/ 5("-( *%3'4(5 "'3(' KG18 9%*6%+'(" .$5+'*$.&(a$3 5%+&%6,5 #(-(5
*%",+,".(" .%2(#'(" '";%.&' $-$+5,"'&5'. &%-%+5'F%$&'+230-"0 V"1+*$2"-"%,*$"'(Q5$c$-3(&*$&'& '";%:5'$"Q *(3(+'( #338 >%+#(&(+.(" #(5( $6&%+N(&' -%":%/(4("
.$5+'*$.&(a$3 -(#( -(#( -(&'%" R!W *%",+,".(" *$+5(3'5(& DAB8
F$'5$1"/% ;0+%"/A"6 0$5/@/" ,$%2$@/9/% 6/% -$1/," 7J #/-$%
9(&'%" #%"/(" R!W &%5%3(4 #'%N(3,(&' #%"/(" &%.&(*( 5'#(. *%"#%+'5( 5,6%+.,3$&'& (.5';Q
&%6('."7( #'$6(5' &%6(/(' '";%.&' 5,6%+.,3$&'& 3(5%" #%"/(" '&$"'(a'# &%3(*( b0e 6,3("
8&%,B%' /J A8.7
?"(. 6%+,&'( s D 5(4," #(" '"#'N'#, &%*,( ,&'( #%"/(" '";%.&' R!W 7("/ *%*'3'.' .$"5(. %+(5
#%"/(" -(&'%" 5,6%+.,3$&'& #(" &%5%3(4 #'%N(3,(&' #%"/(" &%.&(*( 5'#(. *%"#%+'5( 5,6%+.,3$&'&
(.5';Q &%6('."7( #'$6(5' &%6(/(' '";%.&' 3(5%" 5,6%+.,3$&'& #%"/(" '&$"'(a'#8
8&%,B%' /S A8.7
I%4,6,"/(" !"#$"%&'( *%+,-(.(" "%/(+( %"#%*'. Q *(.( 4(3 '"' 6%3,* #'5%+(-.("
#' !"#$"%&'(Q *%","//, 4(&'3 .(2'(" #(+' '*-3%*%"5(&' (E(3 7("/ (.(" #'3(.,.("
$3%4 P%*%"5%+'(" P%&%4(5("8UA
5/21/2018 PNPK TB
60/120
50 TATA LAKSANA TUBERKULOSIS
!&$"'(a'# FP(5%/$+' P%4(*'3(" ?J #'+%.$*%"#(&'.(" ,"5,. -(#( .%4(*'3("
*%&.'-," 5%+#(-(5 -%"'"/.(5(" +'&'.$ 4%-(5$5$.&'&'5(& -(#( '6, 4(*'38Y%2(3( 4(+,&
#'*$"'5$+ #%"/(" -%*%+'.&((" ;,"/&' 4(5' 7("/ #'("2,+.(" &%5'(- O *'"//, -(#( O
2,/( (*(" #(" #'+%.$*%"#(&'.(" -(#( #(%+(4 6%+'&'.$ 5'"//' &%-%+5' .$'";%.&' #%"/("R!W (5(, +'E(7(5 .$"5(. #%"/(" -%"#%+'5( 5,6%+.,3$&'&8UOI,-3%*%"5(&' -'+'#$.&'"
DA*/X4(+' #'("2,+.(" ,"5,. &%5'(- '6, 4(*'3 7("/ *%"/.$"&,*&' '&$"'(a'# .(+%"(
UUQUO
S';(*-'&'" FP(5%/$+' P%4(*'3(" KJ #(-(5 *%"7%6(6.(" -%"#(+(4(" 7("/
6%+4,6,"/(" #%"/(" 4'-$-+$5+$*'"%*'( -(#( 6(7' (-(6'3( #'.$"&,*&' -(#( 5+'*%&5%+
.%5'/( .%4(*'3("8 9%"//,"((" +';(*-'&'" #'+%.$*%"#(&'.(" -(#( '6, 4(*'3 #%"/("5,6%+.,3$&'& #(" N'5(*'" P 4(+,& #'6%+'.(" -(#( '6, FUA*/X4(+'J #(" 6(7' &%5%3(4
*%3(4'+.(" (-(6'3( +';(*-'&'" #'/,"(.(" -(#( 5+'*%&5%+ 5'/( .%4(*'3(" *%"2%3("/
-(+5,&8UO
[5(*6,5$3 FP(5%/$+' P%4(*'3(" ?J #'+%.$*%"#(&'.(" ,"5,. -(#( .%4(*'3("8
9'+(a'"(*'# FP(5%/$+' P%4(*'3(" 6%3,* 5%+&%#'(J8 I(*-(' &((5 '"' 6%3,* 5%+#(-(5
3(-$+(" %;%. &(*-'"/ -%"//,"((" $6(5 '"' -(#( -%"(5(3(.&("((" -(&'%" 8 ?-(6'3(
-'+(a'"(*'# 5'#(. #'/,"(.(" *(.( -(#,(" $6(5 e 6,3(" '&$"'(a'#Q +';(*-'&'" #("
%5(*6,5$3 #'("2,+.("8UO
I5+%-5$*'&'" FP(5%/$+' P%4(*'3(" 6%3,* 5%+&%#'(J 6%+4,6,"/(" #%"/(" $5$5$.&'&'5(&
2("'" #("
\3,$+$.,'"$3$" FP(5%/$+' P%4(*'3(" >VJ 4("7( #'/,"(.(" -(#( E("'5( 4(*'3 (-(6'3(
.%,"5,"/(" 5%+(-' 3%6'4 6%&(+ #'6("#'"/.(" +'&'.$"7( #(" 4("7( #(-(5 #'/,"(.("
$3%4 #$.5%+ 7("/ &,#(4 6%+-%"/(3(*(" #(3(*-%"("/("(" 5,6%+.,3$&'&8UO
M%&.'-," 5%+#(-(5 .$"&%"5+(&' H?< 7("/ #'&%.+%&'.(" -(#( ?I! "(*,"
.$"&%"5+(&'"7( *'"'*(3 #(" 6,.(" *%+,-(.(" .$"5+('"#'.(&' -(#( -%+%*-,("
5/21/2018 PNPK TB
61/120
51Pedoman Nasional Pelayanan Kedokteran
*%"7,&,'8 P$"&%"5+(&' H?< -(#( ?I! &("/(5 +%"#(4 &%4'"//( 5'#(. 6'&( #'("#(3.("
*(.( 4(+,& #'6%+'.(" -(#,(" $6(5 &5("#(+ 7("/ #$&'&"7( &%&,(' #%"/(" 6%+(5 6(#("8
!6, #%"/(" -(+, &%"&'5'; $6(5 #(-(5 *%3("2,5.(" H?< &(*6'3 *%"7,&,' #("
(-(6'3( 5%+6,.5' 5'#(. *%"#%+'5( #(" #''.,5' #%"/(" N(.&'"(&' >KY8 >(7' #%"/("
?I! 4("7( *%"#(-(5.(" OAB #$&'& !=R #'6("#'"/.(" #%"/(" #$&'& 7("/ &%4(+,&"7(
#'#(-(5.(" &%#("/.(" ,"5,. H?< 3('""7( .$"&%"5+(&'"7( 3%6'4 .%:'389(#( -(&'%"
7("/ *%"7,&,'Q H?< #(" ?I! 5%5(- #(-(5 #'6%+'.("Q E(3(,-," 6%6%+(-( H?< #(-(5
*(&,. .% #(3(* ?I!Q (.(" 5%5(-' .$"&%"5+(&'"7( .%:'3 #(" 5'#(. *%"7%6(6.(" 5$.&'.
-(#( 6(7'8 9%*6%+'(" ("5'5,6%+.,3$&'& 7("/ :%-(5 #(" 5%-(5 *%+,-(.(" :(+( 5%+6('.
*%":%/(4 -%",3(+(" #(+' '6, .% 6(7'"7(8UU0UV
9(#( -%+%*-,(" ,&'( -+$#,.5'; 7("/ *%"#(-(5 -%"/$6(5(" #%"/(" +';(*-'&'"Q
#'("2,+.(" ,"5,. 5'#(. *%"//,"(.(" .$"5+(&%-&' 4$+*$"(3Q .(+%"( #(-(5 5%+2(#'
'"5%+(.&' $6(5 7("/ *%"7%6(6.(" %;%.5'N'5(& $6(5 .$"5+(&%-&' 4$+*$"(3 6%+.,+("/8
2 0%'5 B),-%, 0),K%+>& O>,6%* G'=,>+
9(&'%" #%"/(" -%"7(.'5 /'"2(3 .+$"'.Q &%#("/ *%"2(3("' #'(3'&'& &%+5( -(&:(
5+("&-3("5(&' /'"2(3 *%*-,"7(' -%"'"/.(5(" +'&'.$ ,"5,. *%"#%+'5( 5,6%+.,3$&'&8
S%&-$"& 5%+4(#(- ,2' 5,6%+.,3'" *%",+," &%.'5(+ DAB -(#( -(&'%" #%"/(" -%"7(.'5
/'"2(3 .+$"'. &%4'"//( #'(/"$&'& 5'#(. #(-(5 #'&'"/.'+.(" -(#( -(&'%" #%"/("
4(&'3 ,2' 5,6%+.,3'" "%/(5';8 I5(#',* -(#( -%"7(.'5 /'"2(3 .+$"'. (#(3(4`U1
I5(#',* U ` P3'+%"& .+%(5'"'" #(" ;,"/&' "$+*(3 "(*," 5%+#(-(5 .%3('"(" 5+(.5,&
,+'"(+',& &%-%+5' /'"2(3 -$3'.'&5'. #(" &5+,.5,+ (6"$+*(3
I5(#',* O ` P3'+%"& .+%(5'"'" bA0eA *3X*%"'5
I5(#',* V ` P3'+%"& .+%(5'"'" VA0bA *3X*%"'5
I5(#',* 1 ` P3'+%"& .+%(5'"'" UD0VA *3X*%"'5
I5(#',* D ` P3'+%"& .+%(5'"'" sUD *3X*%"'5 #%"/(" (5(, 5("-( #'(3'&'&
5/21/2018 PNPK TB
62/120
52 TATA LAKSANA TUBERKULOSIS
9(&'%" #%"/(" -(+, *(,-," %.&5+( -(+, 4(+,& *%"%+'*( ("5' 5,6%+.,3$&'& &5("#(+
+'E(7(5 -%"/$6(5(" &%6%3,*"7(8
4(+' &%3(*( b 6,3(" (5(, '&$"'(a'# t +';(*-'&'" t -'+'#$.&'" &%3(*( V 6,3(" (5(, +';(*-'&'"
9%"//,"((" '&$"'(a'# 2("/.( -("2("/ 5'#(. #'+%.$*%"#(&'.("8
5,"//(3Q V 6,3(" ,"5,. '&$"'(a'# t +';(*-'&'" (5(, 10b 6,3(" ,"5,. +';(*-'&'" 5,"//(38
-%*%+'.&((" 3%6'4 3("2,5 &%/%+( #'3(.,.("8
P)+=1),B%2> !
T'.( -(&'%" *%","2,..(" /%2(3( *(.( #'3(.,.(" -%*%+'.&((" ,"5,. *%"/'&$3(&'
$+/("'&*% ,"5,. ,2' .%-%.(("8
4
9%"/$6(5(" 7("/ #'("2,+.(" (#(3(4 O 6,3(" '&$"'(a'#Q +';(*-'&'&"Q %5(*6,5$3
#(" -'+(a'"(*'# #'3("2,5.(" #%"/(" 1 6,3(" '&$"'(a'# #(" +';(*-'&'"8 !&$"'(a'# #("+';(*-'&'" #'%3'*'"(&' *%3(3,' %.&+%&' 6'3'%+ &%4'"//( 5'#(. #'-%+3,.(" -%"7%&,('("
#$&'&8 I%3(*( *%"%+'*( '&$"'(a'#Q -(&'%" #%"/(" /("//,(" /'"2(3 *(,-," /(/(3
/'"2(3 4(+,& #'6%+'.(" 6%+&(*( #%"/(" -'+'#$.&'" ,"5,. *%":%/(4 "%,+$-(5' -%+';%+8
[.&+%&' %5(*6,5$3 #(" *%5(6$3'5 -'+(a'"(*'# 5%+2(#' #' /'"2(3 &%4'"//( #'-%+3,.("
-%"7%&,('(" #$&'& ,"5,. .%#,( $6(5 5%+&%6,58 [5(*6,5$3 #'6%+'.(" UD */X./ >>
#(" -'+(a'"(*'# OD */X./ >> &%6("7(. Vc &%*'"//,8 I5+%-5$*'&'" *%"7%6(6.("
5/21/2018 PNPK TB
63/120
53Pedoman Nasional Pelayanan Kedokteran
-%"'"/.(5(" "%;+$5$.&'. #(" $5$5$.&'. &%4'"///( &5+%-5$*'&'" &%6('."7( 5'#(.
#'6%+'.(" -(#( -(&'%" #%"/(" /(/(3 /'"2(3Q "(*," (-(6'3( 4(+,& #'6%+'.(" *(.(
#$&'&"7( UD*/X./>> F#$&'& *(.&'*(3 U /+(*J 7("/ #'6%+'.(" O0V .(3' &%*'"//,
#%"/(" *%*$"'5$+ .(#(+ $6(5 #(3(* #(+(48UV9%"7%&,('(" #$&'& #(3(* -%*6%+'("
*%"2(3("' 4%*$#'(3'&'& #(-(5 #'3'4(5 -(#( .%()* I"/"
.%()* I"/" G$&'& 7("/ #'+%.$*%"#(&'.(" ,"5,. -(&'%" #%E(&( #%"/(" -%",+,"("
;,"/&' /'"2(3 #(" ,"5,. -(&'%" #%E(&( #%"/(" 4%*$#'(3'&'&
@(%& 0)'5(%3%, ;B T')+5),2>U
9=2>2 V T')+5),2> K%,- B>2%'%,+%,
;%B% ;%2>), B),-%, +*>'),
;%2>), B>%*K2>2
!&$"'(a'#
5/21/2018 PNPK TB
64/120
54 TATA LAKSANA TUBERKULOSIS
G,( $6(5 4%-(5$5$.&'.
! e 6,3(" '&$"'(a'# t +';(*-'&'" t %5(*6,5$3
! O 6,3(" '&$"'(a'# t +';(*-'&'" t %5(*6,5$3 t &5+%-5$*'&'" #''.,5' b 6,3("
'&$"'(a'# t +';(*-'&'"
! b0e 6,3(" +';(*-'&'" t -'+(a'"(*'# t %5(*6,5$3
I(5, $6(5 4%-(5$5$.&'.
! O 6,3(" '&$"'(a'#Q %5(*6,5$3Q &5+%-5$*'&'" #''.,5' UA 6,3("
'&$"'(a'#t%5(*6,5$3
J #(-(5 #'/,"(.(" &(5, (5(, #,( $6(5 4%-(5$5$.&'.
&%*%"5(+( &%3,+,4 $6(5 4%-(5$5$.&'. &%3,+,4"7( 4(+,& #'4'"#(+' -(#( &'+$&'&
K4'3# K8
>'3( (#( .%:,+'/((" -%"7(.'5 4(5'Q #'("2,+.(" -%*%+'.&((" ;((3 4(5' &%6%3,*
-%"/$6(5("
9(#( .%3('"(" 4(5'Q -'+(a'"(*'# 5'#(. 6$3%4 #'6%+'.("
9(#,(" $6(5 7("/ #'("2,+.(" F+%.$*%"#(&' ^RHJ '(3(4 OSR[IXbSR (5(,
OR[IXUA R[
9(#( -(&'%" 4%-(5'5'& (.,5 #(" (5(, .3'"'& '.5%+'.Q &%6('."7( H?< #'5,"#( &(*-('
4%-(5'5'& (.,5"7( *%"/(3(*' -%"7%*6,4("8 9(#( .%(#((" &("/(5 #'-%+3,.("
#(-(5 #'6%+'.(" I #(" [M> *(.&'*(3 V 6,3(" &(*-(' 4%-(5'5'& *%"7%*6,4 #("#'3("2,5.(" #%"/(" bSR
I%6('."7( +,2,. .% #$.5%+ &-%&'(3'& -(+, (5(, &-%&'(3'& -%"7(.'5 #(3(*
R%-(5'5'& '*6(& $6(5 6'(&("7( 5%+2(#' t OA 4(+' &%5%3(4 5%+(-' ("5'5,6%+.,3$&'& #'*,3('
#(" 6%+3("/&,"/ &%3(*( t U1 4(+'8 !"&'#%"& .,*,3(5';"7( (#(3(4 OQDDB8 Y%2(3( 7("/
5/21/2018 PNPK TB
65/120
55Pedoman Nasional Pelayanan Kedokteran
-(3'"/ &%+'"/ #'5%*,.(" (#(3(4 *,(3Q *,"5(4 #(" ("$+%.&'(8 I%.'5(+ @eQODB -(&'%"
&%*6,4Q UbQeCB -(&'%" *%"/(3(*' -%+6('.("Q UQCeB -(&'%" /(/(3 #%"/(" &%+,*
IYH< #(" IY9< 5%5(- *%"'"/.(5 #(" UQCeB $+("/ *%"'"//(38U@ \(.5$+ +'&'.$
5%+-%"5'"/ -(#( 4%-(5'5'& '*6(& $6(5 (#(3(4 -%",+,"(" 6%+(5 6(#(" O ./ (5(, 3%6'4
#(3(* 1 *'"//, -%+5(*( -%"/$6(5(" 5,6%+.,3$&'&8 \(.5$+ +'&'.$ 3('""7( 6%+,-('";%.&' 4%-(5'5'& KQ ,&'( pbA 5(4," #(" +%&'&5%"& $6(5 /("#(8UC I%6("7(. VVB
-(&'%" #%"/(" 4%-(5'5'& '*6(& $6(5 5'#(. *%","2,..(" /%2(3( .3'"'& 5%+*(&,. C $+("/
#%"/(" 4%-(5$5$.&'&'5(& 6%+(5 &%4'"//( -%*%+'.&((" ;,"/&' 4(5' 6%+.(3( 6%+/,"(
,"5,. *%"#%5%.&' .%+,&(.(" 4(5' (&'*5$*(5'&Q *%"/,+("/' ("/.( -%+(E(5(" #' SI
#(" *%"'"/.(5.(" .$*-3'("& -%"/$6(5(" 5,6%+.,3$&'&8UeR%-(5'5'& '*6(& $6(5 (#(3(4
.%3('"(" ;,"/&' 4(5' (.'6(5 -%"//,"((" $6(50$6(5 4%-(5$5$.&'.8'3'+,6'" pO
H?< #'4%"5'.("
! IYH
5/21/2018 PNPK TB
66/120
56 TATA LAKSANA TUBERKULOSIS
P%&,3'5(" #'(/"$&'& 5,6%+.,3$&'& -(#( /%+'(5+' (#(3(4 .,+("/"7( .%*(*-,("
-%"#%+'5( ,"5,. *%*6%+'.(" .%5%+("/(" #%"/(" 2%3(& *%"/%"(' /%2(3( 7("/ #'+(&(.("
.(+%"( .%5%+6(5(&(" 5%+5%"5, 7("/ 5%+.('5 ,&'( &%-%+5' 6%+.,+("/"7( *%*$+'Q 5,3'Q
6,5(Q 2+%%+6(/(' -%"%3'5'(" *%","2,..(" 6(4E( ,&'( 3("2,5 *%+,-(.(" -+%#'.5$+
-%"5'"/ 4%-(5$5$.&'&'5(& (.'6(5 !=R #(" +';(*-'&'"8 M(";((5 5%+(-' %5(*6,5$3 #("
&5+%-5$*'&'" 4(+,& #'-%+5'*6("/.(" 5%+4(#(- +'&'.$ #(3(* -%"/%3$3((" -(&'%" ,&'(
3("2,5 #(" #$&'&"7( 2,/( 4(+,& #'&%&,('.(" *%"/'"/(5 %;%. &(*-'"/ 7("/ &%+'"/
5%+2(#' -(#( -(&'%" /%+'(5+'8OAQOU
/0120( 3%,20)0
#$ %&'()' %*+ ,-&'. /+ %&'()' /$ 0&'112.324 5. 6&2 75'3.-454 8 6(2'6)2.6 -9 )515'(: 6;.75'. ? ,27 @24$ AB#AC#DEFEGHIBD"DB$A$ 0&';7&(: J/+ K
5/21/2018 PNPK TB
67/120
57Pedoman Nasional Pelayanan Kedokteran
I$
Y5
KZ5 #>H98[>:DA*A @D6:*7*D< RD8 #9[V
5/21/2018 PNPK TB
68/120
58 TATA LAKSANA TUBERKULOSIS
4"4 N)
(64%#!65K$)$ %!$(#"0"#6
G
&%3('" -(+,&%-%+5' -3%,+(Q .%3%"2(+ /%5(4 6%"'"/Q (6#$*%"Q 5+(.5,&
/%"'5$+'"(+',&Q .,3'5Q 5,3("/ #(" &%"#' &%+5( &%3(-,5 $5(.8 G'(/"$&'& #'6,(5
6%+#(&(+.(" &(5, &-%&'*%" #%"/(" 6'(.(" -$&'5'; (5(, 4'&5$3$/' (5(, 6,.5' .3'"'& .,(5
7("/ .$"&'&5%" #%"/(" 5,6%+.,3$&'& %.&5+(-(+, #(" #''.,5' .%-,5,&(" .3'"'&' ,"5,.
*%*,3(' 5%+(-' ("5'5,6%+.,3$&'&8 9(&'%" #%"/(" #'(/"$&'& 5,6%+.,3$&'& -(+, #("
U
9(#( &%*,( -(&'%" F#%E(&(Q +%*(2( #(" ("(.J 7("/ #'#,/( %.&5+(-(+,Q &-%&'*%" 6(/'("
5,6,4 7("/ 5%+3'6(5 #'(*6'3 ,"5,. -%*%+'.&((" *'.+$&.$-'. #(" #'3(.,.(" -%*%+'.&(("
6'(.(" #(" 4'&5$-(5$3$/' 2'.( ;(&'3'5(& #(" &,*6%+ #(7( *%*(#('8
8&%,B%' F A8.7
>'$-&' 2(+'"/(" #(" (&-'+(&' 2(+,* 4(3,& 6%+5,2,(" ,"5,. *%"#(-(5.(" 6(4(" 7("/
:,.,- ,"5,. #'(/"$&'&8 9%*%+'.&((" 7("/ #'("2,+.(" ,"5,. #'(/"$&'& 5,6%+.,3$&'&
%.&5+(-(+, #(-(5 #'3'4(5 -(#( .%()* J"/"?-(6'3( 5%+#(-(5 .%*,"/.'"(" %.&5+(-(+,
*(.( 6%6%+(-( &(*-%3 #' 6(E(4 '"' 4(+,& #'5%*-(5.(" -(#( -$5 .%+'"/ #(" #'.'+'*
,"5,. 6'(.(" 5,6%+.,3$&'&`O
>'$-&' .%3%"2(+ /%5(4 6%"'"/
9,& 7("/ #'#(-(5.(" -(#( (&-'+(&' .%3%"2(+ /%5(4 6%"'"/
>'$-&' -3%,+( I%3,+,4 &(*-%3 6%#(4 #'.'+'* ,"5,. 6'(.(" +,5'"
I%3,+,4 &(*-%3 +(#'$3$/'& #'.'+'* ,"5,. 6'(.(" +,5'"
I(*-%3 4'&5$3$/'
I(*-%3 (&-'+(&'
I(*-%3 $5$-&'
5/21/2018 PNPK TB
69/120
59Pedoman Nasional Pelayanan Kedokteran
.%()* J"/"9%*%+'.&((" 7("/ #'("2,+.(" ,"5,. #'(/"$&'& 5,6%+.,3$&'& %.&5+(-(+,
@'-%, 0),&'%%, 4>=;2> 4>%+%,
P%3%"2(+ Y%5(4 >%"'"/ 0 =$#,& =$#,& (5(, (&-'+(&'
5/21/2018 PNPK TB
70/120
60 TATA LAKSANA TUBERKULOSIS
!" .5()'+5*=2>2 0*)5'%
Y%2(3( .3'"'& 7("/ -(3'"/ &%+'"/ (#(3(4 6(5,. F@ABJQ "7%+' #(#( F@DBJ #(" #%*(*
#%"/(" #%+(2(5 7("/ +%"#(4 4'"//( 5'"//' FCbBJ8 Y%2(3( 3('" &%-%+5' -%",+,"("
6%+(5 6(#("Q *(3('&%Q .%+'"/(5 *(3(* 4(+' #(-(5 5%+2(#'8 Y%2(3( .3'"'& 7("/ 6%+(5
6%+,-( #%*(* 5'"//' 7("/ *%"%5(- 3%6'4 #(+' O *'"//, (5(, .$"#'&' /(/(3 "(-(&
#'3(-$+.(" 5%+2(#' -(#( @B .(&,&8 93%,+'5'& 4(*-'+ &%3(3, *%3'6(5.(" &(3(4 &(5,
4%*'5$+(.& &(2( FeA0eDBJ8VQ1
5("5("/(" #'(/"$&'&8 G'(/"$&'& -3%,+'5'& 6%+/("5,"/ -(#( 5%+#(-(5"7( 6(&'3
5,6%+.,3$&'& -(#( &-,5,*Q :('+(" -3%,+(Q 6'$-&' -3%,+( *(,-," /+(",3$*( #' -3%,+(
#(+' DUQ@B *%"2(#' @AQbB8O M%5$#% .$"N%"&'$"(3 &%-%+5' -%*%+'.&((" 3("/&,"/
:('+(" -3%,+(Q 6'(.(" :('+(" -3%,+( #(" 6'$-&' -3%,+( 5%+6,.5' 5'#(. :,.,- #(3(*
(#%"$&'"% #%(*'"(&%Q -+$5%'" :('+(" -3%,+(Q 3(.5(5 #%4'#+$/%"(&% #(" .$*-$"%"
&%3,3%+8 9%"%"5,(" (.5'N'5(& (#%"$&'"% #%(*'"(&%Q .(#(+ 3(.5(5 #%4'#+$/%"(&% #("
-3%,+'5'&8 9(&'%" #'#,/( -3%,+'5'& 2'.( &(3(4 &(5, #(+' .%5'/( 5%& 5%+&%6,5 *%","2,..("
-%*%+'.&((" 5%+&%6,5 *%","2,..(" 4(&'3 -$&'5';8 P$*6'"(&' -%*%+'.&((" ("5(+(
DQb
9%"/$6(5(" -3%,+( &(*( #%"/(" -%"/$6(5(" -(+, #%"/(" -(#,(" OSR_[X1SR8
[N(.,(&' :('+(" &%$-5'*(3 *,"/.'" #'3(.,.(" &%&,(' .%(#((" -(&'%" #(" #(-(5
#'6%+'.(" .$+5'.$&5%+$'# FR(5'04(5' -%*6%+'(" .$+5'.$&5%+$'# -(#( #%"/(" 3%&'
3,(& #(" GMJ8 H-%+(&' #'3(.,.(" -(#( .$"#'&' 7("/ 6%+(5 #(" 5'#(. *%*6('. #%"/("
5%+(-' *%#'& &%-%+5' %*-'%*%.5$*'X-3%,+%.5$*' #(" #(-(5 #'&%+5(' #%.$+5'.(&'8@
P%/(/(3(" #'(/"$&'& #(" 5%+(-' -3%,+'5'& #(-(5 *%"7%6(6.(" -%"7(.'5 *%"2(#'
5/21/2018 PNPK TB
71/120
61Pedoman Nasional Pelayanan Kedokteran
-+$/+%&'; #(" #(-(5 *%3'6(5.(" $+/(" 3('" -(#( bDB -(&'%"8 P$*-3'.(&' 7("/
D ** *%3,(& #' &%3,+,4 6(/'(" 4%*'5$+(.& #(" *%"%5(- p C *'"//, &%5%3(4 ;(&%
'"5%+"(3 *(,-," %.&5%+"(38@
4" $>1:%B),=;%&> .5()'+5*=2>2
Z'*;(#%"'5'& &%+N'.(3 5,6%+.,3$&'& #(-(5 5%+2(#' -(#( ,&'( 6%+(-( -," 5%+,5(*(
-(#( ,&'( UA0VA 5(4,"8 Z'*;(#%"$-(5' 3%6'4 &%+'"/ 5%+2(#' -(#( -%+%*-,("8 Y%2(3(
.$"&5'5,&'$"(3 4("7( 5%+2(#' -(#( VV0CDB -(&'%"8 G'(/"$&'& #'5%/(..(" *%3(3,'
/+(",3$*(5$,& .(&%$&(#%"/("&%3 Z("/4("&8C
2 8%*5'%, W'=-),>&%*
R(3 7("/ -(3'"/ -%"5'"/ (#(3(4 ("(*"%&'& -(&'%"8 S'E(7(5 '";%.&' 5,6%+.,3$&'&
&%6%3,*"7( 6('. 5,6%+.,3$&'& -(+, *(,-," %.&5+(-(+, *%*6%+'.(" -%5,"2,. -%"5'"/
-(#( 6("7(. .(&,&8 9%+'$#% 3(5%" ("5(+( '";%.&' 5,6%+.,3$&'& #(" 5,6%+.,3$&'& &(3,+("
,+$/%"'5(3 #(-(5 *%":(-(' VA 5(4,"8 Y("//,(" *'.&' #(" ,+/%"&' .+$"'. 7("/ 5'#(.
5/21/2018 PNPK TB
72/120
62 TATA LAKSANA TUBERKULOSIS
+%&-$"& 5%+4(#(- ("5'6'$5'. #(-(5 *%"/(+(4 .%-(#( 5,6%+.,3$&'& &(3,+(" ,+$/%"'5(38
[-'#'#'*'*'5'& .+$"'. *%+,-(.(" *("';%&5(&' 5,6%+.,3$&'&&(3,+(" ,+$/%"'5(3 7("/
-(3'"/ &%+'"/ #'5%*,.(" -(#( &(3,+(" /%"'5(3 3(.'03(.'Q 6'(&("7( #'5%*,.(" 6%+&(*(
-'"//("/ #(" &,-+(-,6'.Q 4%*(5,+'(Q ;+%.,%"&' *'.&' 6%+5(*6(4#(" "$.5,+'(8 9(&'%"6'(&("7( *%"/%3,4 *'.&' 7("/ &%#'.'50&%#'.'5 #(" &%+'"/ 7("/ (E(3"7( 4("7( 5%+2(#'
#' *(3(* 4(+' #(" .%*,#'(" #'+(&(.(" 2,/( -(#( &'("/ 4(+'8 P$3'. /'"2(3 2(+("/
#'5%*,.("Q 4("7( 5%+2(#' -(#( UA -%+&%" -(&'%"8 Y%2(3( .$"&5'5,&' &%-%+5' #%*(*Q
-%",+,"(" 6%+(5 6(#(" &%+5( .%+'"/(5 *(3(* 2,/( 2(+("/ #'5%*,.("8 Y%2(3( 6'(&("7(
'"5%+*'5%" #(" &,#(4 6%+3("/&,"/ 6%6%+(-( &((5 &%6%3,* -(&'%" *%":(+' -%"/$6(5("8
R%*(5$&-%+*'(Q &'&5'5'& +%.,+%" &%+5( -%*6%"/.(.(" 5%&5'& 7("/ *%"'*6,3.(" +(&(
"7%+' #(-(5 2,/( #'5%*,.(" -(#( 5,6%+.,3$&'& &(3,+(" ,+$/%"'5(38UA
G'(/"$&'& *'.+$6'$3$/' 5,6%+.,3$&'& &(3,+(" ,+$/%"'5(3 #'5%/(..(" *%3(3,' '&$3(&'
$+/("'&*% -%"7%6(6 #(+' ,+'" (5(, 6'$-&' 2(+'"/(" -(#( *%#'( -(#(5 .$"N%"&'$"(3
(5(, +(#'$*%5+'8 I%5'#(."7( V &-%&'*%" ,+'" -(/' 4(+' FD &-%&'*%" 3%6'4 6('.J
#'6'(..(" -(#( FUJ *%#'( 6'(.(" Z$E%"&5%'"0T%"&%" ,"5,. *%"/'&$3(&' !Q -5Q
5/2"##$ 2/#'$--$:.&$1"% F>KYJ #(" *'.$6(.5%+'( "$"5,6%+.,3$&'& FOJ*%#'( 5%3,+
!Q 5+*"0Q 7("/ *%+,-(.("
("(%+$6 -(+&'(3#(" 5,*6,4 #'6(E(4 -%+*,.((" *%#'( 6'(.("8
5/21/2018 PNPK TB
73/120
63Pedoman Nasional Pelayanan Kedokteran
L+'" 6'(&("7( &5%+'3 #(" -(#( &%6(/'(" 6%&(+ FCABJ -(&'%" *%"/("#,"/ 3%,.$&'58
R%*(5,+'( *(.+$&.$-'. 5%+2(#' -(#( UAB -(&'%" &%#("/.(" 4%*(5,+'( *'.+$&.$-'.
5%+2(#' -(#( 4(*-'+ DAB -(&'%"8UA
9%*%+'.&((" ;$5$ -$3$& &(3,+(" ,+$/%"'5(3 &("/(5 -%"5'"/ .(+%"( #(-(5 *%","2,..("
-(#( (E(3 -%"7(.'5 #(-(5 *%"#%5%.&' -%+,6(4(" -(#( &(5, .(3'.& 6%+,-( "%.+$&'&
-(+%".'*8 Z%&' /'"2(3 #(-(5 5(*-(. &%6(/(' #'&5$+&' .(3'.&8 9(#( .(3'.& #(-(5 5%+2(#'
6%+(5 #(" #%&5+,.&' -(+%".'*8 9(#( &5(#',* 3("2,5 #(-(5 #'5%*,.(" #'&5$+&' .(3'&%(3Q
UA
9+$&%#,+ G'(/"$&'&
5/21/2018 PNPK TB
74/120
64 TATA LAKSANA TUBERKULOSIS
I%6("7(.DA0@DB 3(.'03(.' #%"/(" 5,6%+.,3$&'& /%"'5(3 *%*-,"7(' .%3('"(" +(#'$3$/'& #'
&(3,+(" .%*'4 &%4'"//( 3$.(&' -+'*%+ #' %-'#'#'*'& 4(+,& #'-%+'.&(8P)+=1),B%2> 4
9(#,(" $6(5 ("5'5,6%+.,3$&'& &5("#(+ &%3(*( b 6,3(" %;%.5'; ,"5,. 5,6%+.,3$&'&&(3,+(" ,+$/%"'5(3 5("-( .$*-3'.(&'8 9%+5'*6("/(" .4,&,'3(.,.(" (-(6'3( 5%+#(-(5
/("//,(" ;,"/&' /'"2(38 M%&.'-," -(#,(" $6(5 ("5'5,6%+.,3$&'& *%+,-(.(" 5%+(-'
,5(*( "(*," -+$&%#,+ 6%#(4 &%-%+5' 6%#(4 (63(&' #(-(5#'3(.,.(" -(#( &%-&'& (5(,
(6&%&8 [.&'&' 6%#(4 -(#( /'"2(3 7("/ &,#(4 5'#(. 6%+;,"/&' 3(/' (5(, 3%&' 3,(& -(#(
/'"2(3 7("/ ;,"/&'"7( 4("7( &%6(/'(" *(&'4 *%"2(#' .$"5+$N%+&'8 =%;+%.5$*'
#''"#'.(&'.(" (-(6'3( 5%+2(#' .$*-3'.(&' &%-%+5' '";%.&' &(3,+(" .%*'4 (5(& 6%+(5
#%"/(" 6(.5%+' /+(* -$&'5'; *(,-," /+(* "%/(5';Q 6(5, #(" 4'-%+5%"&'8 >%#(4+%.$"&5+,.&' #'-%+3,.(" 5%+,5(*( ,"5,. *%*-%+6('.' &5+'.5,+ -(#( ,+%5%+ UXV #'&5(3
6,3(" -%+5(*( ;(&% '"5%"&'; ("5'5,6%+.,3$&'&8UAQUO
G,+(&' -%"/$6(5(" 5,6%+.,3$&'& &(3,+(" ,+$/%"'5(3 (#(3(4 b 6,3(" ,"5,. .(&,& 5("-(
.$*-3'.(&'8 2 8>2&)1 8%'%: 052%&
I%6(/'(" 6%&(+ -(&'%" #%"/(" *%"'"/'5'& *%*'3'.' +'E(7(5 &(.'5 .%-(3( #%"/("
.%3,4(" 5'#(. .4(& &%3(*( O0C *'"//, &%6%3,* 5'*6,3"7( /%2(3( '+'5(&' *%"'"/%(38
.%-(3(8 H+("/ #%E(&( 6'(&("7( *%","2,..(" /%2(3( .3(&'. *%"'"/'5'&Q 7('5, #%*(*Q
5/21/2018 PNPK TB
75/120
65Pedoman Nasional Pelayanan Kedokteran
-%+'3(., #(" -%",+,"(" .%&(#(+("8 S'E(7(5 4("7( #'#(-(5.(" -(#( &%.'5(+ UAB
-(&'%"8 \$5$5$+(.& 7("/ *%","2,..(" -(+,#'5%*,.(" -(#( VA0DAB -(&'%"8
I%.'5(+ UAB -(&'%" *%"'"/'5'& 2,/( *%"/(3(*' 5,3("/ 6%3(.("/8 ?-(6'3(
*%"'"/'5'&5'#(. #'$6(5' *(.( #(-(5 *%"7%6(6.(" .%+,&(.(" $5(. &%-%+5' /("//,("
*%"5(3Q -(+(3'&'& *$5$+'.Q .%2("/ &%+5( -%+'3(., (6"$+*(38UVQU1
Z'4(5 O%1(%' J"/"S%.$*%"#(&'`UD
U8
5/21/2018 PNPK TB
76/120
66 TATA LAKSANA TUBERKULOSIS
#'5(E(+.(" ,"5,. -%*%+'.&((" R!W8 9+'"&'- #'(/"$&'& #(" -%"(5(3(.&("(("
&,&,"(" &(+(; -,&(5 &(*( -(#( -(&'%" #%"/(" #(" 5("-( '";%.&' R!W *%&.'-,"
'";%.&' R!W *%*-%+3,(& #'(/"$&'& 6("#'"/ #(" 5%+(-' ("5' +%5+$N'+(3 *%*-%+&,3'5
-%"("/("("8
9%"%*,(" >
5/21/2018 PNPK TB
77/120
67Pedoman Nasional Pelayanan Kedokteran
I%5'(- -(&'%" *%"'"/'5'& 4(+,& #'3(.,.(" =7:82/%.%-(3( #%"/(" .$"5+(& &%6%3,*
#'5%+(-' (5(, #(3(* 1C 2(* -%+5(*( 5%+(-'
=7:82/% .%-(3( #(-(5 *%*6("5, #'(/"$&'& *%"'"/'5'& #(" *%*6%+'.(" '";$+*(&'
#(&(+ 7("/ -%"5'"/ 5%+,5(*( ,"5,. -%+5'*6("/(" '"5%+N%"&' 6%#(4 -(#( 4'#+$&%;(3,&
I%*,( -(&'%"#%"/(" 5,6%+.,3$*( &%+%6+(3 (5(, 5,6%+.,3$&'& &-'"(3 &%6('."7( #'3(.,.("MS! ,"5,. *%"%"5,.(" -%+3,"7( '"5%+N%"&' 6%#(4 #(" *%3'4(5 +%&-$"& 5%+(-'
I%3,+,4 -(&'%" 4(+,& *%*-,"7(' ;$5$ 5$+(.&
P)+=1),B%2> !
S%.$*%"#(&' -(#,(" $6(5 5%+(-' 3'"' -%+5(*( ,"5,. &%/(3( 6%"5,. 5,6%+.,3$&'& &'&5%*
&(+(; -,&(5 &%3(*( *'"'*(3 UO 6,3("8
I%5'(- -(&'%" *%"'"/'5'& #'6%+'.(" .$+5'.$&5%+$'# 5("-( *%*("#("/ 5'"/.(5 .%-(+(4("
G$&'& .$+5'.$&5%+$'# ,"5,. #%E(&( Fp U1 5(4,"J #(-(5 #'*,3(' #(+' AQ1 */X./66X4(+'
#%"/(" 5(--%+'"/ $;; #(3(* b0C *'"//,
5/21/2018 PNPK TB
78/120
68 TATA LAKSANA TUBERKULOSIS
O%1(%' J"/"?3/$+'5*( #'(/"$&'& 5,6%+.,3$&'& &,&,"(" &(+(; -,&(5
G'.,5'- #(+' FUUJ
Q" .5()'+5*=2>2 .5*%,- B%, 8),B>
&%4'"//( *%"7%6(6.(" .%5%+3(*6(5(" #'(/"$&'& #(" #%&5+,.&' 5,3("/ #(" &%"#'8
R("7( DAB -(&'%" #%"/(" 5,6%+.,3$&'& 5,3("/ #(" &%"#' 7("/ ;$5$ 5$+(.&"7( &%&,('
5/21/2018 PNPK TB
79/120
69Pedoman Nasional Pelayanan Kedokteran
#%"/(" &%4'"//( *%",5,-' #'(/"$&'&8 =7%+' (5(, 6%"/.(. *%+,-(.(" .%3,4("
7("/ -(3'"/ &%+'"/ #'5%*,'8 G%*(* #(" -%",+,"(" 6%+(5 6(#(" 4("7( 5%+#(-(5 -(#(
6%6%+(-( -(&'%"8 \'&5,3( .,3'5Q (6&%&Q #%;$+*'5(& &%"#' #(-(5 #'5%*,.(" -(#( -%"7(.'5
3("2,58UbQU@
9(&'%" #(-(5 *%"/(3(*' *(3('&%Q -%",+,"(" 6%+(5 6(#("Q -%",+,"(" "(;&, *(.("Q
.%+'"/(5 *(3(* #(" #%*(* -(#( *(3(* 4(+'Q 5,3("/ 6%3(.("/ .(., #(" "7%+' 6'3(
#'/%+(..(" &%+5( #%;$+*'5(& .';$&'& 7("/ "7%+' 6'3( #'-%+.,&'8 (., %*(& ,"5,. #'(/"$&'& 5,6%+.,3$&'& 5,3("/ #(" &%"#' (#(3(4 6'(.("
*'.$6(.5%+',* 2(+'"/(" 5,3("/ (5(, :('+("&'"$N'(38 ?&-'+(&' 2(+,* #(" 6'$-&' F=7:
@&"6$6
'-%+';%+ 6'(&("7( 5'#(. *%*6("5,8 P%:,+'/((" 5%+4(#(- '";%.&' *%+,-(.("
'"#'.(&' 6'$-&' &'"$N'(38 L2' &%"&'5'N'5(& ("5'*'.+$6'(3 '&$3(5 -%"5'"/ #'.%+2(.("8U@
5/21/2018 PNPK TB
80/120
70 TATA LAKSANA TUBERKULOSIS
&%-%+5' 6(3$" -(#( 5,3("/ ;(3("/8 \$5$ 5$+(.& #(-(5 #'3(.,.(" ,"5,. *%"/%5(4,'
6%.(& (5(, -(+,8 9%*%+'.&((" MS! #(-( 5*%"%"5,.(" -%+3,(&(" '";%.&' .%
2(+'"/(" 3,"(. #(" &5+,.5,+ #' &%.'5(+ 5,3("/ &%-%+5' *%#,3(&-'"(3'&8UbQU@
9%"/$6(5(" 6'(&("7( #'6%+'.(" &%3(*( e0UO 6,3(" #%"/(" *%*-%+5'*6("/.("
*%*$"'5$ ++%&-$" &-%"/$6(5("8 S%&-$"& .3'"'& -(3'"/ 6('. #'"'3(' *%3(3,' '"#':(5$+
.3'"'& &%-%+5' "7%+'Q /%2(3( .$"&5'5,&'$"(3Q *$6'3'5(& #(" 5("#( "%,+$3$/'&8U@
P$*-3'.(&' 5%+-%"5'"/ &-$"#'3'5'& (#(3(4 .$*-+%&' .$+#( &-'"(3'&8 9(&'%"
&-$"#'3'5'& *%*-,"7(' +'&'.$ -(+(-(+%&'& (5(, -(+(-3%/'( 7("/ #'6(/' *%"2(#'`Ub
U8 9(+(-3%/'( (E'5(" :%-(5Q *%+,-(.(" ;(&% (.5'; -%"7(.'5 N%+5%6+( (E'5(""7( #(3(*
5,6%+.%3Q (6&%& 5,6%+.%3Q 2(+'"/(" -%+.'2,(" 5,6%+.%3 (5(, 7("/ 2(+("/ #'5%*,.("
#(3(* 3%&' '&.%*'. .$+#( &-'"(3'&8
O8 9(+(-3%/'( (E'5(" 3(*6(5Q *,":,3 3%6'4 #(+' O 5(4," &%5%3(4 -%"7(.'5 #'5%*,.("
#' .$3,* N%+5%6+(8 P$*-3'.(&' "%,+$3$/'& #(-(5 6%+4,6,"/(" #%/(" -%"7(.'5
(5(, .$*-+%&' *%.("'. -(#( .$+#( &-'"(3'&8 9(5$3$/' 7("/ #(-(5 5%+2(#' (#(3(42(+'"/(" -%+.'2,("Q #%6+'& 5,6%+.%3Q /'6,& '"5%+"(3Q &5%"$&'& .("(3'& N%+5%6+( (5(,
/("//,(" *$5$+'.8
!"#'.(&' 6%#(4 -(#( 5,6%+:,3$&'& 5,3("/ #(" &%"#' (#(3(4`Ub
U8 P$*-3'.(&' "%,+$3$/'& 7("/ 5'#(. +%&-$"& 5%+4(#(- 5%+(-' .$"&%+N(5';
O8 G%&5+,.&' 5,3("/ -+$/+%&';
V8
5/21/2018 PNPK TB
81/120
71Pedoman Nasional Pelayanan Kedokteran
T" .5()'+5*=2>2 O%2&'=>,&)2&>,%*
Y%2(3( 7("/ -(3'"/ &%+'"/ #'5%*,.(" (#(3(4 "7%+' -%+,5 FCAQbBJQ -%",+,"(" 6%+(5
6(#(" F@1QbBJQ #'(+%X.$"&5'-(&' FODQ1 BJQ #'(+% FUbQ1BJQ #(+(4 -(#( +%.5,* FUUQeBJQ
"7%+' 5%.(" (6#$*%" FV@QV BJQ *(&&( (6#$*%" FUVQ1BJ #(" 3'*;(#%"$-(5' FUQDBJ8
Z%&' *(.+$&.$-'. 7("/ #'5%*,.(" -(#( %"#$&.$-' -(3'"/ &%+'"/ #'5%*,.(" #'
&%6%3(4 .("(" F:(%:,* #(" (&:%"#'"/ :$3$"J #(" ,3.,& -+'*%+ F,3.,& CC BQ "$#,3
DAQ@BQ -%"7%*-'5(" 3,*%" F11QCBJQ 3%&' -$3'-$'# UAQ1BJ8 I%5%3(4 5%+(-'
&%6(/'(" 6%&(+ ,3.,& C@QOBQ "$#,3 C1QbBQ 3%&' -$3'-$'# CDQ@BQ -%"7%*-'5(" 3,*%"
@bQOB #(" #%;$+*'5(& .(5,- '3%$0&(%.(3 F@bQDBJ *%"/(3(*' +%&$3,&'8 H+/(" 7("/
-(3'"/ &%+'"/ 5%+3'6(5 (#(3(4 '3%,* 5%+*'"(3 .(+%"( -+%N(3%"& .%3%"2(+ /%5(4 6%"'"/
#' #(%+(4 5%+&%6,5 5'"//' #(" E(.5, .$"5(. '&' ,&,& 4(3,& 3%6'4 3(*(8 Z%&' 7("/ -(3'"/
&%+'"/ #'5%*,.(" (#(3(4 ,3.,& #(" -%"7%*-'5(" 3,*%" -(3'"/ &%+'"/ #'5%*,.(" #'
,&,& 4(3,&8UC
%6%+(-( -(&'%" 5%+.(#("/ #'#'(/"$&'& #%"/("
6"0$/0$#(" *%"#(-(5.(" $6(50$6(5(" '*,"$&,-+%&(" 7("/ *%"7%6(6.(" -%"7%6(+("
3%6'4 3("2,58UC
Y%2(3( .3'"'& #(-(5 6%+,-( /%2(3( (.,5 *(,-," .+$"'. '"5%+*'5%"8 I%6(/'(" 6%&(+
-(&'%" *%"/(3(*' "7%+' -%+,5Q #%*(*Q #'(+% #(" .$"&5'-(&'Q -%",+,"(" 6%+(5 6(#("Q
("$+%.&'( #(" *(3('&%8 9(&'%" #%"/(" -%+'5$"%,*6'(&("7( 6%+*("';%&5(&' &%6(/('
/(&5+$'"5%&5'"(3Q #'5%*,.(" -(#( '"#'N'#, 6%+,&'( s1A 5(4," #(" ;+%.,%"&'"7(
-%"7(.'5 /(&5+$'"5%&5'"(3 3('""7( &%-%+5' Q .(".%+ $N(+',*
3("2,5Q *'.$&'& #(3(*Q '";%.&' ]%+&'"'( #(" (*%6$*(&8 9(&'%" #%"/(" -%+'5$"%,*
#(-(5 *%"/(3(*' -%*6%&(+(" (6#$*%" *,3(' #(+' (&'5%& #(" "7%+' -%+,58 ?#4%&'
5%.(" (6&$*%" #';,&Q 6+&@93 /56+'$%Q 4%-(5$*%/(3' #(" (&'5%&8 \(.5$+ +'&'.$
5/21/2018 PNPK TB
82/120
72 TATA LAKSANA TUBERKULOSIS
-%+'5$"%,* (#(3(4 '";%.&' R!WQ &'+$&'&Q #'(6%5%& *%3'5,& .%/("(&(" #(" *%"%+'*(
#'(3'&'& -%+'5$"%(38UCQUe
5/21/2018 PNPK TB
83/120
73Pedoman Nasional Pelayanan Kedokteran
*%&.'-," 5%+#(-(5 /+(",3$*( .(&%$&(8 9%*%+'.&((" 3(-(+$&.$-' #(" 3(-(+(5$*'
#'.(5%/$5'.(" *%"2(#' V .%3$*-$. 7('5,`Ue
U8 9%+'5$"%,* 7("/ #'-%",4' #%"/(" 5,6%+.%3 *,35'-%3
O8 9%"%6(3(" -%+'5$"',*
V8
51
5/21/2018 PNPK TB
84/120
74 TATA LAKSANA TUBERKULOSIS
#'6(/' *%"2(#' V 6(/'("Q 7('5, ,"5,. -%*%+'.&((" 4'&5$-(5$3$/'Q 6'(.(" #("
&%"&'5'N'5(&Q &%+5( ,"5,. '"$.,3(&' -(#( 4%E(" -%+:$6(("8 9%*%+'.&((" 5%+(.4'+ 2(+("/
#'.%+2(.(" .(+%"( 5'#(. 5%+&%#'( 3,(&8 G'5%*,.(""7( 5,6%+.%3 -(#( &%#'((" 4(&'3
.,+%5(&% %"#$*%5+',* *%"#,.,"/ #'(/"$&'& %"#$*%5+'(38 9%*%+'.&((" >
5/21/2018 PNPK TB
85/120
75Pedoman Nasional Pelayanan Kedokteran
#(" -%*6%&(+(" "$#,& 3'*;(5'.,& *%#'(&5'"(3X5+(.%$6+$".'(38 9%+'.(+#'$&'"5%&'&
#'3(.,.(" ,"5,. 5,2,(" #'(/"$&5': #(" 5%+(-%,5'.8 9%+'.(+#'$&'"5%&'& 5%+(-%,5'.
#'3(.,.(" -(#( 5(*-$"(#% 2("5,"/8 K('+(" 7("/ #'(*6' 34(+,& #'-%+'.&(.(" ,"5,.
6'(.("Q ("(3'&'& :('+(" ,"5,. *%*6%#(.(" %.&,#(5 (5(, 5+("&,#(5Q &%+5(Q ,2' '"#'+%.
&%-%+5' '"5%+;%+$" /(**( (5(, (#%"'"% #%(*'"(&% F?G?J 2'.( #'-%+3,.("8 W(+'(6'3'5(%5%.&' 6(&'3 5,6%+.%3 -(#( -%*%+'.&((" -,3(&(" 3("/&,"/ :('+(" -%+'.(+#'(3 6%+N(+'(&'
("5(+( A01OB8 >'(.(" -$&'5'; :('+(" -%+'.(+#'(3 6%+N(+'(&' ("5(+( DA0@DB8G'(/"$&'&
OD
U8 >'(.("!Q -5-$&'5'; #(+' %;,&' -%+'.(+#'(3 (5(, 2(+'"/("
O8 >
5/21/2018 PNPK TB
86/120
76 TATA LAKSANA TUBERKULOSIS
9%*6%+'(" .$+5'.$&5%+$'# #%"/(" #$&'& -+%#"'&$3$" U */X./66 #%"/(" 5(--%+'"/ $;;
#(3(* UU *'"//,
P)+=1),B%2> !
A" .5()'+5*=2>2 G5*>&
!"N(&' .,3'5 !Q -&5$12+0"0 2(+("/ #'5%*,.(" #' "%/(+( *(2,8 9%",3(+(" 5%+2(#'
(.'6(5 '"4(3(&' #+$-3%5 #(" 2(+("/ #'&%6(6.(" $3%4 '"$.,3(&' 3("/&,"/ #' .,3'58OC
9+%&%"5(&' .3'"'& .,3'5 6%+,-( 3%&' .+$"'.Q 5'#(. "7%+'Q "$"0-(5$/"$*$"'.Q #(-(5
6%+,-( -(-,3( .%:'3 #(" %+'5%*( 4'"//( 5,6%+.,3$*( 6%&(+8OeM%&.'-," *$+;$3$/'
3%&' &("/(5 6%+N(+'(&'Q 5%+#(-(5 6%6%+(-( 5%*,(" .4(&Q 7('5, /(*6(+("021+
5/21/2018 PNPK TB
87/120
77Pedoman Nasional Pelayanan Kedokteran
.%()* J"F "
7=,&=3
5+,+ 8%'E%3+,+' Q+2=-),` 5,6%+.3$&'& 29/%21$Q N%+,.$&( .,5'&Q 3,-,& N,3/(+'&
Q,B=-),`
! ! R%*(5$/%"` *'3'%+ (.,5Q (6&%& *%5(&5(5'.Q 3,-,&
N,3/(+'&
! Z'*;(5'.` 3,-,& N,3/(+'&
F%'#( 3+B*%,# E5*&>(%2>*)'` 29/%21$
*'3'%+ (.,5Q /,*(5$&(
0%52>(%2>*)'` N%+,.$&( .,5'&Q 3,-,& N,3/(+'&Q 5,6%+.,3'#
G'.,5'-#(+'FVUJ
5/21/2018 PNPK TB
88/120
78 TATA LAKSANA TUBERKULOSIS
9(&'%" #%"/(" %.&5+(-(+,Q -(#,(" $6(5 &%3(*( b0e 6,3(" FO 6,3(" !=RQ S!\Q 9_?Q #("
[M> #''.,5' #%"/(" 10@ 6,3(" !=R #(" S!\J
9%"/%:,(3'(" +%.$*%"#(&' b0e 6,3(" ,"5,. %.&5+(-(+, -(#( &'&5%* &(+(; -,&(5
F5,6%+.,3$*( (5(, *%"'"/'5'&J #(" 5,3("/ #(" &%"#'Q 7('5, &%3(*( e0UO 6,3("
!
(&& T>
5/21/2018 PNPK TB
89/120
79Pedoman Nasional Pelayanan Kedokteran
#B$
##$
#A$
#D$
AI$
#E$
#I$
AB$
A#$
AA$
AD$
AE$
AI$
6&2 75'3.-454 '.7 )'.'32)2.6 -9 N2(5='(75'1 7542'424 -9 6&2 K;(-N2'. 4-=526: -9 ='(75-1-3:$
R2()'6-1$ AB#BCEEFDGHADD"I$
5/21/2018 PNPK TB
90/120
80 TATA LAKSANA TUBERKULOSIS
$
DB$
D#$
DA$
5/21/2018 PNPK TB
91/120
81Pedoman Nasional Pelayanan Kedokteran
4"4 N))
(64%#!65K$)$ 0"2" "'"!
5/21/2018 PNPK TB
93/120
83Pedoman Nasional Pelayanan Kedokteran
4" 9>%-,=2>2 .4 %,%+
G'(/"$&'& -(&5' (#(3(4 #%"/(" *%"%*,.(" .,*(" -%"7%6(6 7('5, !Q
-&5$12+0"0-(#( -%*%+'.&((" &-,5,*Q 6'3(& 3(*6,"/Q :('+(" &%+%6+$&-'"(3Q :('+("
-3%,+( (5(,-," 6'$-&' 2(+'"/("8 M%"/'"/(5 .%&,3'5(" -%"%/(.(" #'(/"$&'& -(&5'Q *(.(
S%.$*%"#(&' -%"#%.(5(" #'(/"$&'& -(#( ("(.`O
U8 ?"(*"%&'& F+'E(7(5 .$"5(. %+(5 #%"/(" -(&'%" #(" /%2(3( .3'"'& &%&,(' J
O8
V8 L2' 5,6%+.,3'"
18
D8 9%*%+'.&((" -%","2("/ 3('" 7("/ +%3%N(" F;$5$ 5$+(.& 5$+(.&Q -,"/&' 3,*6(3Q
6'$-&' #(" 7("/ 3('""7( &%&,(' 3$.(&' $+/(" 7("/ 5%+.%"(J
b8 I.+'"'"/ R!W -(#( .(&,& #%"/(" .%:,+'/((" R!W
("(. *%+,-(.(" -%"7(.'5 '";%.&' &'&5%*'. #(" $+/(" 7("/ -(3'"/ &%+'"/ 5%+.%"(
(#(3(4 -(+,8 Y%2(3( .3'"'& -%"7(.'5 '"' #(-(5 6%+,-( /%2(3( &'&5%*'. X ,*,* (5(,&%&,(' $+/(" 5%+.('58 Y%2(3( .3'"'& -(#( ("(. 5'#(. .4(&Q .(+%"( /%2(3( &%+,-(
2,/( #(-(5 #'&%6(6.(" $3%4 6%+6(/(' -%"7(.'5 &%3('" 8
J
%+%:1$'"--"%@F5'#(. -%+"(4
+%#( (5(, '"5%"&'5(& &%*(.'" 3(*( &%*(.'" -(+(4J #(" -%"7%6(6 3('" 6(5,. 5%3(4
#'&'"/.'+.("8
#%*(* 5';$'#Q '";%.&' &(3,+(" .%*'4Q *(3(+'(Q #(" 3('"03('"J8 G%*(* ,*,*"7(
5'#(. 5'"//' F&,6;%6+'&J #(" #(-(5 #'&%+5(' .%+'"/(5 *(3(*8
=(;&, *(.(" 5'#(. (#( F("$+%.&'(J (5(, 6%+.,+("/Q #'&%+5(' /(/(3 5,*6,4 K%+(5 6(#(" 5,+," &%3(*( O0V 6,3(" 6%+5,+,505,+,5 5("-( &%6(6 7("/ 2%3(& ?
5/21/2018 PNPK TB
94/120
84 TATA LAKSANA TUBERKULOSIS
6%+(5 6(#(" 5'#(. "('. #%"/(" (#%.,(5 ?
5/21/2018 PNPK TB
95/120
85Pedoman Nasional Pelayanan Kedokteran
D8 *(5(`
+%V&%2-"*"-"0 ,9#32-$%/1"0LQ
5/21/2018 PNPK TB
96/120
86 TATA LAKSANA TUBERKULOSIS
("5'/%" F5,6%+.,3$-+$5%'"J 7("/ #'6%+'.("8 R(3 '"' &%:(+( 5'#(. 3("/&,"/
*%"("#(.(" 6(4E( -%+"(4 (#( .,*(" 7("/ *(&,. .% #(3(* 5,6,4 ("(.Q (+5'"7(
("(. &,#(4 5%+'";%.&' 8 ?"(. 7("/ 5%+'";%.&' F4(&'3 ,2' 5,6%+.,3'" -$&'5';J
6%3,* 5%"5, &(.'5 .(+%"( 5,6,4 -(&'%" *%*'3'.' #(7( 5(4(" 5,6,4 (5(, '*,"'5(&7("/ :,.,- ,"5,. *%3(E(" .,*(" 8@>'3( #(7( 5(4(" 5,6,4 ("(. :,.,- 6('. *(.(
&%:(+( .3'"'& ("(. F-(&'%"J (.(" 5(*-(. &%4(58 P%(#((" '"' #'&%6,5 &%6(/(' '";%.&'
3(5%"8 =(*," (-(6'3( #(7( 5(4(" 5,6,4 ("(. 3%*(4 #(" 5'#(. *(*-, *%"/%"#(3'.("
.,*("Q *(.( ("(. (.(" *%"2(#' &(.'5 &%+5( *%","2,..(" /%2(3( .3'"'& #("
+(#'$3$/'&8 L2' 5,6%+.,3'" +%3(5'; *,#(4 #(" *,+(4Q -%"%3'5'(" *%","2,..(" 6(4E(
-$5%"&' 5,6%+.,3'" 5%5(- .$"&5(" &%5%3(4 N'(3 #'6,.( &%3(*( U 6,3("8C
!=\[PI! F Z(5%"J
I?P!<
?%H%,#B(++' I+,+@ $+' )%,0&0!#(
I%3('" ,2' 5,6%+.,3'"Q 6("7(. -%*%+'.&((" #(+(4 7("/ 6%+%#(+ &%:(+( .$*%+&'(3
#%"/(" 5,2,(" *%"'3(' +%&-$"& '*," 5,6,4 5%+4(#(- &%-%+5' 4(3"7( ,2' 5,6%+.,3'"8
>,.5'06,.5' *%","2,..(" 6(4E( -%*%+'.&(("0-%*%+'.&((" 5%+&%6,5 5'#(. 3%6'4
,"//,3 #(+'-(#( ,2' 5,6%+.,3'"8 9%*%+'.&((" ;%-$1
5/21/2018 PNPK TB
97/120
87Pedoman Nasional Pelayanan Kedokteran
L2' 5,6%+.,3'" *%+,-(.(" (3(5 #'(/"$&'& 7("/ -(3'"/ 6('. ,"5,. *%*6,.5'.(" (#("7(
'";%.&' 8
9%*%+'.&((" !YS? *%*-,"7(' -$5%"&' .%,"//,3(" #'6("#'"/ ,2' 5,6%+.,3'"Q "(*,"
&5,#' -(#( ("(. 6%3,* 6("7(.8 R(+/( -%*%+'.&((" !YS? +%3(5'; *(4(3 #(" &((5 '"' 6%3,*
5%+&%#'( #' !"#$"%&'(8 9%*%+'.&((" &%+$3$/' 5'#(. #'+%.$*%"#(&'.(" -%"//,"((""7( 6('. ,"5,. #'(/"$&5'.
-(#( -(&'%" #%E(&( *(,-," ("(.8
9%*%+'.&((" #(+(4 FZ[GQ 3'*;$&'5$&'&J 5'#(. (#( +,2,.(""7(Q #(" 5'#(. #'("2,+.(" #(3(*
-%#$*(" #'(/"$&'& "(&'$"(3 *(,-," '"5%+"(&'$"(3
?%H%,#B(++' J+B*%,#0&0!#(
#(" !32+5/2-$1"&' -&5$12+0"0 #(+' 6'(.(" (5(, *%5$#% -%*%+'.&((" 3('""7(8
#%"/(" ;(&'3'5(& 5%+6(5(&8 I-%&'*%" 7("/ 5%-(5 #(+' $+/(" 7("/ 5%+3'6(5 #'%N(3,(&'
,"5,. -%*%+'.&((" 6(.5%+'$3$/'& 7('5, #%"/(" -,3(&(" 3("/&,"/ F6"1$2- 0'$/1J ,"5,.
*%"%*,.(" 6(&'3 5(4(" (&(* F>
5/21/2018 PNPK TB
98/120
88 TATA LAKSANA TUBERKULOSIS
&%*,( ,*,+Q #%"/(" 4(&'3 7("/ 3%6'4 6('. #(+'-(#( (&-'+(&' 3(*6,"/Q 5%+,5(*(
(-(6'3( *%"//,"(.(" 3%6'4 #(+' U &(*-%38 9%*%+'.&((" &(*-%3 #(+' U '"#,.&'
&-,5,* *%"/4(&'3.(" V .(3' "'3(' -$&'5'; 7("/ 3%6'4 5'"//' #(+'-(#( (&-'+(&'
3(*6,"/8UVQU1 M%5$#% '"' (*(" #(" +%3(5'; *,#(4 &%4'"//( 6'&( #'.%+2(.("
-(#( -(&'%" +(E(5 2(3("8 L"5,. *%3(.,.(""7( #'-%+3,.(" -%3(5'4(" #("-%+(3(5(" 7("/ &%#%+4("(8
?%H%,#B(++' C#(*08+*0&0!#
9%*%+'.&((" 4'&5$-(5$3$/' F9?X9(5$3$/' ?"(5$*'J #(-(5 *%*6%+'.(" /(*6(+("
7("/ .4(&Q 7('5, *%","2,..(" /(*6(+(" /+(",3$*( #%"/(" "%.+$&'& -%+.'2,(" #'
5%"/(4"7( #(" #(-(5 -,3( #'5%*,.(" /(*6(+(" &%3 #(5'( 3("/4("& #(" (5(, .,*("
8 >'3( -(#( &,(5, .(&,& 7("/ #':,+'/(' %.&5+(-(+, #(" *%*%+3,.(" 5'"#(.("
6%#(4 7("/ *%+,-(.(" .%&%*-(5(" 6('. *%"#(-(5.(" &-%&'*%"Q -%*%+'.&(("
4'&5$-(5$3$' 4%"#(."7( #'3(.,.("8 !#%(3"7( -%*%+'.&((" 4'&5$-(5$3$/' #'3(.,.("
-(#( &-%&'*%" 7("/ #'-%+$3%4 #%"/(" :(+( 6'$-&' %.&'&'8 >'3( 5'#(. *%*,"/.'".("
*%3(.,.(" 6'$-&' %.&'&' *(.( -%*%+'.&((" 6'$-&' (&-'+(&' 2(+,* 4(3,& F
/0,"1/-"+% 5"+,03\P]XJJ #(-(5 *%*6("5, -%"%/(.(" #'(/"$&'& -(#( ("(.8UD
?%H%,#B(++' 10*0 *0,+B(
9%*%+'.&((" -%","2("/ 3('" 7("/ :,.,- -%"5'"/ (#(3(4 -%*%+'.&((" ;$5$ 5$+(.&8
=(*," /(*6(+(" ;$5$ 5$+(.& -(#( 5'#(. .4(& .(+%"( 2,/( #(-(5 #'2,*-('
-(#( -%"7(.'5 3('"8 I%3('" '5,Q N(+'(6'3'5(& ("5(+ -%*6(:( 4(&'3 ;$5$ 5$+(.& :,.,-
6%&(+8UbG%"/(" #%*'.'(" -%*%+'.&((" ;$5$ 5$+(.& &(2( 5'#(. #(-(5 #'/,"(.(" ,"5,.
*%"#'(/"$&'& Q .%:,(3' /(*6(+(" *'3'%+8 I%:(+( ,*,*Q /(*6(+(" +(#'$3$/'&
7("/ *%","2("/ (#(3(4 &%6(/(' 6%+'.,5`
(8
&%3('" #%"/(" ;$5$ 5$+(.& ?9Q 4(+,& #'&%+5(' ;$5$ 5$+(.& 3(5%+(3J
68 P$"&$3'#(&' &%/*%"5(3X3$6(+
:8 [;,&' -3%,+(
#8 M'3'%+
%8 ?5%3%.5(&'&
5/21/2018 PNPK TB
99/120
89Pedoman Nasional Pelayanan Kedokteran
;8 P(N'5(&
/8
48
5/21/2018 PNPK TB
100/120
90 TATA LAKSANA TUBERKULOSIS
7" 9>%-,=2>2 .4 ;%B% %,%+ B),-%, 2>2&)1 2+='>,-
9%"//,"((" &'&5%* &.$+'"/ 6("7(. *%"/,"#("/ .$"5+$N%+&'Q .(+%"( 6%6%+(-(
&5,#' *%","2,..(" 6(4E( &'&5%* &.$+'"/ :,.,- 6('. "(*," 6("7(. &5,#' 3('"
7("/ *%"7(5(.(" 6("7(. .%3%*(4(" 7("/ #'*'3'.' &'&5%* &.$+'"/8 >,.5' 7("/ (#(
*%","2,..(" 6("7(. .%3%*(4(" &'&5%* &.$+'"/8Ue=(*," #%*'.'("Q 5%"(/( .%&%4(5("
#' 3(7("(" .%&%4(5(" #%"/(" ;(&'3'5(& 5%+6(5(& X 3(7("(" -+'*%+ &%+'"/.(3' *%"/(3(*'
.%&,3'5(" *%"#'(/"$&'& -(#( ?"(.8 I%3('" .%5%+6(5(&(" (3(5 #'(/"$&'&Q 5'(#("7(
5%"(/( #$.5%+ 2,/( *%"2(#' .%"#(3( #'(/"$&'& -(#( ("(.8 R(3 '"' *%"7%6(6.("
6%&(+(" *(&(3(4 -(#( ("(. 5'#(. 5%+#(5( .(+%"( 5%"(/( .%&%4(5(" #' 3(7("("
.%&%4(5(" -+'*%+ +(/, (5(, .,+("/ -%+(7( #'+' ,"5,. *%"#'(/"$&'& ("(. &%4'"//(
5%+2(#' &%6$1:6"/@%+0"08 G' &'&' 3('" (/(."7( 2,&5+, 5%+2(#' +*$1:6"/@%+0"0 ("(. #'
3(7("(" &E(&5( .(+%"( :%"#%+,"/ *%"//(*-("/.("8
I'&5%* &.$+'"/ #'(/"$&'& ?"(. 7("/ #'&,&," $3%4 9$.2( ?"(. P%*%".%&
S! #(" !.(5(" G$.5%+ ?"(. !"#$"%&'( F!G?!J *%*6("5, 5%"(/( .%&%4(5(" (/(+
5'#(. 5%+3%E(5 #(3(* *%"/,*-,3.(" #(5( .3'"'& *(,-," -%*%+'.&((" -%","2("/
&%#%+4("( &%4'"//( #'4(+(-.(" #(-(5 *%"/,+("/' 5%+2(#'"7( &%6$16"/@%+0"0*(,-,"
+*$16"/@%+0"08OA
?"(. #'"7(5(.(" ,1+5/5#$ 2'.( &.$+'"/ *%":(-(' "'3(' b (5(, 3%6'48 =(*,"
#%*'.'("Q 2'.( ("(. 7("/ .$"5(. #%"/(" -(&'%" >
5/21/2018 PNPK TB
101/120
91Pedoman Nasional Pelayanan Kedokteran
8>2&)1 2+='>,- B>%-,=2>2 .4 !,%+ B> :%2>*>&%2 ;)*%K%,%, +)2)3%&%, ;'>1)'OA
0%'%1)&)' Y / C F 8+='
P$"5(.
5/21/2018 PNPK TB
102/120
92 TATA LAKSANA TUBERKULOSIS
#%"/(" &'&5%* &.$+'"/ ("(.
" 9(&'%" ,&'( 6(3'5( 7("/ *%"#(-(5 &.$+ DQ #%"/(" /%2(3( .3'"'& 7("/ *%+(/,.("Q
*(.( -(&'%" 5%+&%6,5 #'+,2,. .% SI ,"5,. %N(3,(&' 3%6'4 3("2,5
I'&5%* &.$+'"/ 4("7( #'/,"(.(" #' ;(&'3'5(& .%&%4(5(" -+'*%+ 7("/ 5%+6(5(&Q 6('.
.%5%+6(5(&(" 5%"(/( *%#'& *(,-," -%+("/.(5 #'(/"$&'&
P(&,& 7("/ *%+(/,.(" 4(+,& #'+,2,. .% ;(&'3'5(& .%&%4(5(" 7("/ 3%6'4 3%"/.(-
L"5,. ;(&'3'5(& 3(7("(" .%&%4(5(" 7("/ 3%6'4 3%"/.(-Q &'&5%* &.$+'"/ #(-(5 #'/,"(.("
&%6(/(' -%"(-'&(" (E(3Q "(*," 4(+,& #'3%"/.(-' #%"/(" -%*%+'.&((" #'(/"$&'& 7("/
3%6'4 3%"/.(-
S%.$*%"#(&' K
I%5%3(4 #'"7(5(.(" &%6(/(' -(&'%" -(#( ("(. #(" #'6%+'.(" -%"/$6(5(" H?
5/21/2018 PNPK TB
105/120
95Pedoman Nasional Pelayanan Kedokteran
9" J%,+* $+' ,#'!+''E+ 8%'E+B#*
U8 +'"/("` 5'#(. 6%+'&'.$ *%"'*6,3.(" .%:(:(5(" 6%+(5 (5(, .%*(5'("Q *'&(3"7(
-+'*%+ 5("-( .$*-3'.(&'Q .,3'5Q .%3%"2(+ #33
O8 6%+(5` -(#( ("(. 7("/ 6%+'&'.$ *%"'*6,3.(" .%:(:(5(" 6%+(5 (5(,
.%*(5'("Q *'&(3"7( *%"'"/'5'&Q *'3'%+Q 5,3("/ #(" &%"#'Q (6#$*%"Q
5%+*(&,. 4%-(+Q ,&,&Q -(+, >
5/21/2018 PNPK TB
106/120
96 TATA LAKSANA TUBERKULOSIS
>J #'6("#'"/.(" ("(. 6%&(+
(5(, #%E(&(8OUQOOT%"'& ("5' 3'"' -%+5(*( #(" #$&'&"7( 5%+:("5,* #(3(* .%()* Z"/"
5/21/2018 PNPK TB
107/120
97Pedoman Nasional Pelayanan Kedokteran
.%()* Z"/" H?< 7("/ #'-(.(' #(" #$&'&"7(
[%1% @(%&
9=2>2 3%'>%,
9=2>2
1%+2>1%*
Q:)+ 2%1;>,-
!&$"'(a'# FRJ UA F@0UDJ VAA R%-(5'5'&Q "%,+'5'& -%+';%+Q4'-%+&%"&'5'N'5'&
S';(*-'&'" FSJ UD FUA0OAJ bAA
Y(&5+$'"5%&5'"(3Q +%(.&' .,3'5Q
4%-(5'5'&Q 5+$*6$&'5$-%"'(Q
-%"'"/.(5(" %"a'* 4(5'Q :('+("
5,6,4 6%+E(+"( $+("7% .%*%+(4("
9'+(a'"(*'# F_J VD FVA01AJ 0
5/21/2018 PNPK TB
108/120
98 TATA LAKSANA TUBERKULOSIS
&%+5( +%.$*%"#(&' -%*6%+'(" 1 *(:(* H?< -(#( ;(&% '"5%"&'; 5'#(. &%.,(5 -(#(
$+("/ #%E(&(Q .%:,(3' -(#( >
5/21/2018 PNPK TB
109/120
99Pedoman Nasional Pelayanan Kedokteran
N0,*#B0(*%,0#$
P$+5'.$&5%+$'# #(-(5 #'/,"(.(" ,"5,. #%"/(" .$*-3'.(&' &%-%+5'f *%"'"/'5'& Q
&,*6(5(" 2(3(" "(-(& (.'6(5 .%3%"2(+Q #(" -%+'.(+#'5'& 8 9(#( .$"#'&' *%"'"/'5'&
6%+(5 .$+5'.$&5%+$'# *%"'"/.(5.(" &,+N'N(3 #(" *%",+,".(" *$+6'#'5(&Q &%4'"//(
.$+5'$&5%+$'# #'("2,+.(" -(#( .(&,& *%"'"/'5'& 8ODI5%+$'# #(-(5 -,3( #'6%+'.("
-(#( *'3'%+ #%"/(" /("//,(" "(-(& 7("/ 6%+(5Q %;,&' -3%,+( #(" (6#$*%"
#%"/(" (&'5%&8 H6(5 7("/ &%+'"/ #'/,"(.(" (#(3(4 -+%#"'&$" #%"/(" #$&'& O */X./X
4(+'Q &(*-(' 1 */X./X4(+' -(#( .(&,& &(.'5 6%+(5Q #%"/(" #$&'& *(.&'*(3 bA */X4(+'
&%3(*( 1 *'"//,Q .%*,#'(" -/,,$1"%@:+
5/21/2018 PNPK TB
110/120
100 TATA LAKSANA TUBERKULOSIS
9%*6%+'(" *(.("(" 5(*6(4(" &%6('."7( #'6%+'.(" #%"/(" *(.("(" 7("/ *,#(4
#'5%+'*( ("(. #(" 6%+N(+'(&'8 T'.( 5'#(. *%*,"/.'".(" #(-(5 #'6%+'.(" &,-3%*%"5(&'
",5+'&' &(*-(' ("(. &5(6'3 #(" #(-(5 #' (5(&'8
?#,#$0B(#'
#%"/(" *(3",5+'&' 6%+(5 #(" ("(. #%"/(" R!W 7("/ *%"#(-(5.(" ?SW8 I,-3%*%"5(&'
-'+'#$.&'" FD0UA */X4(+'J #'+%.$*%"#(&'.(" -(#( 6(7' 7("/ *%"#(-(5 ?I! %.&3,&';Q
R!W -$&'5'; (5(, *(3",5+'&' 6%+(58O
9" .%&% *%+2%,% ):)+ 2%1;>,- =(%&
[;%. &(*-'"/ $6(5 3%6'4 2(+("/ 5%+2(#' -(#( ("(. #'6("#'"/.(" #%E(&(8 9%*6%+'("
%5(*6,5$3 ,"5,. ("(. 7("/ *%"/(3(*' 6%+(5 5'#(. 6("7(. *%"'*6,3.(" /%2(3(
%;%. &(*-'"/ &%3(*( -%*6%+'(""7( &%&,(' #%"/(" +%"5("/ #$&'& 7("/ #'+%.$*%"#(&'8O@
[;%. &(*-'"/ 7("/ -(3'"/ -%"5'"/ (#(3(4 4%-(5$5$.&'&'5(&Q 7("/ #(-(5 #'&%6(6.("
$3%4 '&$"'(a'#Q +';(*-'&'" (5(, -'+(a'"(*'#8 ["a'* 4(5' 5'#(. +,5'" #'-%+'.&(Q -(#(
.%(#((" -%"'"/.(5(" %"a'* 4(5' +'"/(" 5("-( /%2(3( .3'"'& F.,+("/ #(+' D .(3' "'3('
"$+*(3J 6,.(" *%+,-(.(" '"#'.(&' -%"/4%"5'(" 5%+(-' $6(5 ("5' 8 T'.( 5'*6,3 /%2(3(4%-(5$*%/(3' (5(, '.5%+,& 4(+,& &%/%+( #'3(.,.(" -%"/,.,+(" .(#(+ %"a'* 4(5' #("
2'.( -%+3, -%"/4%"5'(" $6(5 8 9%"(-'&(" .% (+(4 -%"7%6(6 4%-(5'5'& 3('" 4(+,&
#'3(.,.("8 H6(5 #'6%+'.(" .%*6(3' 2'.( ;,"/&' 4(5' .%*6(3' "$+*(3Q #'6%+'.("
#%"/(" #$&'& 7("/ 3%6'4 .%:'3 #(3(* +%"5("/ 5%+(-'Q #%"/(" 5%5(- *%*$"'5$+ .(#(+
%"a'* 4(5'8 P$"&,35(&' .% (43' 4%-(5$3$/' #'-%+3,.(" ,"5,. 5(5( 3(.&("( 3%6'4 3("2,58OC
Q" 0),
5/21/2018 PNPK TB
111/120
101Pedoman Nasional Pelayanan Kedokteran
%;%. *%"/,"5,"/.(" #(" #'.4(E(5'+.(" #(-(5 *%"'*6,3.(" >KY0'5'& #'&%*'"(5(Q
7('5, -%"7(.'5 (.5'; (.'6(5 -%*6%+'(" >KY -(#( -(&'%" '*,"$.$*-+$*(&8
^RH *%"%5(-.(" 6(4E( N(.&'"(&' >KY *%+,-(.(" .$"5+('"#'.(&' -(#( ("(.
5%+'";%.&' R!W 7("/ 6%+/%2(3(8 R(3 '"' &%+'"/ *%"2(#' #'3%*( 6'3( 6(7' *%"#(-(5>KY &%/%+( &%5%3(4 3(4'+ -(#( &((5 &5(5,& R!W0"7( 6%3,* #'.%5(4,'8 >'3( &5(5,& R!W
'6, 5%3(4 #'.%5(4,' #("F1$*$%-"%@ !+-9$1 -+ =9"#6 71/%0'"00"+% +
5/21/2018 PNPK TB
112/120
102 TATA LAKSANA TUBERKULOSIS
(5(, 5'#(. 5%+'";%.&' F,2' 5,6%+.,3'" "%/(5';J8 9(#( ("(. #%"/(" .$"5(. %+(5 7("/
.%-(#( ("(.0("(. #%"/(" 6,.5' '";%.&' F,2' 5,6%+.,3'" (5(, !YS? -$&'5';J "(*,"
5'#(. 5%+#(-(5 /%2(3( #(" 5("#( .3'"'& 8OQ VU
G$&'& #(" 3(*( -%*6%+'(" !=R &(*(#%"/(" -%":%/(4(" -+'*%+8
("(. 6(3'5( #(" ("(. '*,"$.$*-+$*('& #' &%/(3( ,&'( 7("/ .$"5(. %+(5 #%"/("
-(&'%" >
5/21/2018 PNPK TB
113/120
103Pedoman Nasional Pelayanan Kedokteran
#-1-2=- 2==2Z= 2%< E7$1
5/21/2018 PNPK TB
114/120
104 TATA LAKSANA TUBERKULOSIS
/45 Y?%21< ;6: U2#$+P A!: Y$2E?% *O5 '7- 372#82E?"$%-+$E= 2%< 372#82E?
5/21/2018 PNPK TB
115/120
105Pedoman Nasional Pelayanan Kedokteran
K#1"')$"$) O"'1 (%#5)4"(
U8 P%*%"5+'(" P%&%