protocol of tb treatment

7/28/2019 Protocol of TB Treatment

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National protocol for

tuberculosis treatment


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Target patients

1. pt who discharging tubercle bacilli which can

be demonstrated by sputum microscopic

examination i.e smear positive (open case)2. pt with bacteriologically unconfirmed TB

(Person with suspected TB based on clinical or

X-ray appearance, suffering from extra

pulmonary TB, contact with smear positive pt


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BCG vaccination

*It is L.A vaccine given by intra dermal injection*It given to people considered to be non-infected

(children) to protect them from developing TBspecially severe form of the disease.

*Dose 0.05 ml in < 1year, 0.1 ml in >1year*Complication:

1. subcutaneous abscess at site of infection

2. Ulceration at the site of injection

3. Swelling + ulceration LN adjacent to thevaccination site

4. Systemic complication


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Case finding

Diagnosis of tuberculosis by identification of TBbacilli either by smear microscopy or culture

Smear examination done for suspected TB

cases (even extra pulmonary) Clinical examination and Chest X-ray finding

suggestive of TB helpful in smear -ve pts inpulmonary in small children and miliary cases.

Mantoux test is helpful in children suspected ofTB who are less 5 years and have not receivedBCG vaccination


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Pulmonary TB is present when:

1. There 2 +ve result of sputum

examination

2. In case withve smear with highly

suggestive clinical and chest x-ray

finding

3. Children with clinical symptoms and +ve

mantoux (in non-vaccinated children)


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Treatment of tuberculosis

TB treatment must not be started until a firmdiagnosis has been made

The recommendation is to adopt a new 8monthregimen with HE in the continuation phase

recategorizing the TB patient into 2 categories oftreatment instead of 3.

CAT-1: includes all new cases ( smear +ve and

ve ) in addition to extra pulmonary cases.CAT-2 : includes retreatment cases ( failure,

relapse, return after default).


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CAT-1 treatment

Rifampicin

Isoniazide

Streptomycin

Pyrazinamide

Initial phase

(2 month(

Ethambutol

Isoniazide

Continuation phase

(6 month)

*In children


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CAT-2 treatment (retreatment)Rifampicin

IsoniazideStreptomycin

Pyrazinamide

Ethmbutol

Initial phase

(2month)

(1month)

Rifampicin

Isonizide

Pyrazinamide

Ethmbutol

Ethambutol

Isoniazide

Rifampicin

Continuation phase

(6 month)


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Strength/tab

Dose/kgDrug

100mg5mgIsoniazide (H)

150mg10 mgRifampicin(R)

400mg25mgpyrazinamide

400mg

Initial 20-25mg

Continuation 15mg

Ethambutol

Inj 750mg15mgStreptomycin

150/75mg10/5mgRifina (RH)

Dosing for anti tuberculosis drugs


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Common Side effects of anti tuberculosis drug

INH: neurotoxicity & liver damage.

Rifampicin: hepatitis, change color of body

secretion to pink

Strreptomycin: vestibular damage

Pyrazinamide: hepatitis and artheralgia

Thiacetazone: anemia, GI upsets Ethambutol:decrease in visual acuity,

blirring with redgreen color blind ness


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Contacts of smear +ve cases

Children aged 6 years and over :

>> investigate them for TB if they have symptoms or signs of TB.

Children und er 6 year old:

>> first check tuberculin test

*if not vaccinated &tuberculin +ve =treat fully for TB

*if nt vaccinated &tuberculinve= give Rifina for 3 months thencheck tuberculin at the end of 3 months.

*if stilllve stop Rifina and give BCG vaccination

A newborn of amother wi th open TB:

>> infant given INH for 3months then check mantoux test

* if +ve = treat for 6 month in all

* ifve = stop INH and give BCG vaccination

Breast feeding should continue


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Defaulters

All cases default for more than 3 months

are candidate for full treatment.

Default in initial phase more than 2 weeks

restart treatment

Default in continuation phase less than 1

month check mantoux

if +ve =restart the treatment

ifve =contiue the treatment


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Definitions

Smear positive relapses:

Pt with smear positive pulmonary TB,previously treated for active TB who

declared cured after completion of acourse of chemotherapy of TB.

Smear positive failure cases:

Pt who are do not show, or temporarilyshow, sputum conversion while receivingtreatment for TB with first-line regimen


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Drug resistance :

1. Naturally : due to bacterial mutations

2. Acquired or secondary : with in corrrect

chemotherapy therapy eg. Treatment

with single potent drug in smear =ve pt.

3. Primary resistance: pt with acquired

resistance infect a healthy individual .

protocol of tb treatment

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