Anti-Tubercular Treatment Regime

ANTI-TUBERCULAR TREATMENT REGIME


ANTI-TUBERCULAR REGIME

  • Based on RNTCP (2010 guidelines).
  • RNTCP (Revised National Tuberculosis Control Programme) is an application of WHO.
  • This recommends strategy of DOTS in India. 
  • It is largely based on the research done at National Tuberculosis Institute, Bangalore and Tuberculosis Research Centre, Chennai.

OBJECTIVES:

  • Detecting at least 70% of sputum positive tuberculosis patients in the community.
  • Curing at least 85% of the newly detected sputum positive cases.

COMPONENTS OF DOTS

  • DOTS – Directly observed treatment strategy.
    • Direct observation of drug intake
  • Political and administrative commitment at all levels.
  • Diagnosis through sputum microscopy.
  • Uninterrupted supply of short course chemotherapy drugs.
  • Systematic monitoring, evaluation and supervision at all levels.

TREATMENT SCHEDULE:

Category-1: 

  • Newly diagnosed patients with no previous exposure to anti-tubercular agents or took anti-tubercular agents less than one month.

Category-2

  • Old patient taken anti-tubercular agents more than 1 month.
    • Treatment failure cases.
    • Relapse cases.
    • Return after interruption.
  • Treatment is divided into,
    • Intensive phase (IP).
    • Continuation phase (CP). 
  • All the therapies are thrice weekly.
  • Sputum smear is done at end of IP. 
    • If positive for AFB, then IP is extended for one more month.

DRUG REGIMEN:

  • Category- 1: 2(H3 R3 Z3 E3) 4 ( H3 R3 )
  • Category- 2: 2( S3 H3 R3 Z3 E3)+ 1( H3 R3 Z3 E3 ) 5 ( H3 R3 E3)
  • Category- 3: 2( H3 R3 Z3 ) 4 ( H3 R3 )
    • H= INH 600mg, 
    • R= Rifampicin 450mg, 
    • Z= Pyrazinamide 1500mg,
    • E= Ethambutol 1200mg, 
    • S= Streptomycin 750 mg
  • Cat 2(H3 R3 Z3 E3) 4 ( H3 R3 ) means initial two months of therapy with INH, Rifampicin, Pyrazinamide and Ethambutol in a thrice-weekly schedule followed by INH and rifampicin for a period of 4 months in a thrice-weekly schedule.

Treatment in the RNTCP (Revised National TB Control Programme) 

  • DOTS Medication is to be taken in presence of a health worker
  • Consists of 2 phases –
    • Initial intensive phase and a second continuation phase.
  • The total duration of treatment is 6-9 months.
  • The intensive phase lasts for 2-4 months.
    • In this phase, a health worker watches as the patient swallows the drugs in his presence. Treatment is given thrice a week on alternate days and every dose is directly observed.
  • The continuation phase lasts for 4-5 months depending on the patient’s response to treatment. 
    • Continuation phase drugs are given in a multi-blister combipack.
    • In this phase, the first dose of the medicine every week is taken by the patient under direct observation, while the other doses are taken by the patient himself. The patient is requested to bring the previous week’s blister pack when coming to collect the next week’s blister pack.
  • The colour of boxes (containing the drugs for full course of treatment) is according to the category of regimen : –
    • Category I patients —> Red.
    • Category II patients —> Blue.
    • Category III patients –> Green

Daily dose regime in RNTCP (2016):

  • Recommended for,
    • Tb in children
    • Tb in patients with HIV
    • Drug-sensitive Tb in 104 cities identified by pilot project.
Major changes recommended from RNTCP-2010 are
  • Daily therapy rather than intermittent.
  • HRE in continuation phase than HR.
  • No need for IP extension even if smear is positive.

NON DOTS REGIMEN:

  • Daily self-administered non-DOTS regime is followed in extremely rare circumstances where there is an adverse reaction to drugs used in the short – course therapy or when the patient is not able to comply with the regimen.

The 2 regimes are as given below:

  • ND1 regime – For new sputum +ve pulmonary seriously ill patients and extrapulmonary seriously ill patients – 2(SHE) + 10(HE).
  • ND2 regime – For sputum -ve pulmonary not seriously ill patients and extrapulmonary not seriously ill patients – 12(HE)

Exam Important

  • Dots Plus regime consist of 6Km Ofx Eto Cs ZE + 18 Ofx Eto CsE
  • To be termed as cured a patient who was initially smeared positive and completed treatment should have a negative smear result on at least 2 occasions of which one should be at treatment completion.
  • ND2 regime – For sputum -ve pulmonary not seriously ill patients and extrapulmonary not seriously ill patients – 12(HE)
  • In DOTS continuation phase drugs are given in a multi-blister combi-pack.
  • DOTS medication is to be taken in presence of a health worker
  • Alternate day treatment is recommended in DOTS.
Don’t Forget to Solve all the previous Year Question asked on ANTI-TUBERCULAR TREATMENT REGIME

Module Below Start Quiz

Leave a Reply

Free Mini Course on Stomach

Mini Course – Stomach

22 High Yield Topics in Stomach

in Just 2 Hours

Submission received, thank you!

Close Window
%d bloggers like this:
Malcare WordPress Security