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    Recent TB Treatment Guidelines

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    Dr venkatesh jallu
    Tuberculosis remains a major global health problem, with about 1/3 of the world's population infected and over 9 million new cases annually. In India it is the most common cause of death from an infectious disease, with over 600 deaths per day. The Revised National Tuberculosis Control Program (RNTCP) was launched in 1997 to address this issue using the WHO-recommended DOTS strategy. Diagnosis involves identifying presumptive cases based on symptoms and confirming with smear microscopy. Treatment regimens vary depending on drug sensitivity but generally involve a combination of first-line drugs over 6-9 months. Multi-drug resistant TB requires longer and more expensive treatment with second-line drugs. Guidelines provide classifications and

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    Recent TB Treatment Guidelines

    Uploaded by

    Dr venkatesh jallu
    142 views28 pages
    Tuberculosis remains a major global health problem, with about 1/3 of the world's population infected and over 9 million new cases annually. In India it is the most common cause of death from an infectious disease, with over 600 deaths per day. The Revised National Tuberculosis Control Program (RNTCP) was launched in 1997 to address this issue using the WHO-recommended DOTS strategy. Diagnosis involves identifying presumptive cases based on symptoms and confirming with smear microscopy. Treatment regimens vary depending on drug sensitivity but generally involve a combination of first-line drugs over 6-9 months. Multi-drug resistant TB requires longer and more expensive treatment with second-line drugs. Guidelines provide classifications and

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    RECENT TB TREATMENT GUIDELINES

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    Tuberculosis remains a major global health problem, with about 1/3 of the world's population infected and over 9 million new cases annually. In India it is the most common cause of death from an infectious disease, with over 600 deaths per day. The Revised National Tuberculosis Control Program (RNTCP) was launched in 1997 to address this issue using the WHO-recommended DOTS strategy. Diagnosis involves identifying presumptive cases based on symptoms and confirming with smear microscopy. Treatment regimens vary depending on drug sensitivity but generally involve a combination of first-line drugs over 6-9 months. Multi-drug resistant TB requires longer and more expensive treatment with second-line drugs. Guidelines provide classifications and

    Copyright:

    © All Rights Reserved
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    Download as pptx, pdf, or txt
    142 views28 pages

    Recent TB Treatment Guidelines

    Uploaded by

    Dr venkatesh jallu
    Tuberculosis remains a major global health problem, with about 1/3 of the world's population infected and over 9 million new cases annually. In India it is the most common cause of death from an infectious disease, with over 600 deaths per day. The Revised National Tuberculosis Control Program (RNTCP) was launched in 1997 to address this issue using the WHO-recommended DOTS strategy. Diagnosis involves identifying presumptive cases based on symptoms and confirming with smear microscopy. Treatment regimens vary depending on drug sensitivity but generally involve a combination of first-line drugs over 6-9 months. Multi-drug resistant TB requires longer and more expensive treatment with second-line drugs. Guidelines provide classifications and

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    RECENT TB TREATMENT

    GUIDELINES
    DR VENKATESH
    INTRODUCTION

    About 1/3 of world population is infected with M.TB, out of which


    10-15% will develop disease in their life time.

    9.6 million cases world wide , 2.2 million in India.

    KD TRIPATHI 8TH EDITION, RNTCP Techinical and operational guidelines for tuberculosis control in india, 2016, global tuberculosis
    report 2015, WHO Geneva. HARRISONS 20 TH EDITION.
    INTRODUCTION

    - Most common cause of death due to infectious disease in india


    (600/day)

    - In 2012 it was declared as notifiable disease in India.

    - RNTCP was launched in 1997 and was revised lastly in 2016.

    • KD TRIPATHI 8TH EDITION, RNTCP Technical and operational guidelines for tuberculosis control in India, 2016, global tuberculosis
    report 2015, WHO Geneva. HARRISONS 20 TH EDITION.
    DEFINITIONS

    New A TB patient who has never had treatment for TB or has taken anti-TB
    drugs for less than one month.

    Relapse A TB patient who was declared cured or treatment completed by


    a physician and who reports back to the health facility and is now found to
    be sputum smear positive.

    • KD TRIPATHI 8TH EDITION, RNTCP Techinical and operational guidelines for tuberculosis control in india, 2016, global tuberculosis
    report 2015, WHO Geneva. HARRISONS 20 TH EDITION. K.PARK 24TH EDITION
    Treatment after default: A patient, who has received treatment for TB for
    a month or more from any source and returns for treatment after having
    defaulted i.e., not taken anti-TB drugs consecutively for two months or
    more and found to be smear –positive.
    Treatment failure Any TB patient who is smear-positive at 5 months or
    more after initiation of treatment
    Defaulted A Patient after treatment initiation has interrupted treatment
    consecutively for >2 months

    • KD TRIPATHI 8TH EDITION, RNTCP Techinical and operational guidelines for tuberculosis control in india, 2016, global tuberculosis
    report 2015, WHO Geneva. HARRISONS 20 TH EDITION. K.PARK 24TH EDITION
    Case definitions - WHO

    Tuberculous intrathoracic lymphadenopathy (mediastinal and/or hilar) or


    tuberculous pleural effusion,without radiographic abnormalities in the
    Lungs, constitutes a case of extrapulmonary TB.

    A patient with both pulmonary and extrapulmonary TB should be


    classified as a case of pulmonary TB.
    DIAGNOSIS

    PRESUMPTIVE T.B
    1) Cough > 2weeks.
    2) fever > 2weeks.
    3) weight loss or no weight gain in children.
    4) night sweats.
    • PASTE
    A.T.T – DOTS AND NON DOTS

    First line drugs ( group 1)- drugs with high anti tubercular efficacy as well
    as low toxicity.
    Isoniazid
    Rifampicin
    Pyrazinamide
    Ethambutol
    Second line drugs – low anti tubercular activity or higher toxicity or both,
    and are used when first line drugs cannot be used or to supplement them.
    Group ii ( injectable drugs)- streptomycin, kanamycin, amikacin,
    capreomycin.
    Group iii – fluoroquinolones.
    Group iv – ethionamide, protionamide, cycloserine, PAS, rifabutin,
    rifapentine.
    Group v-( unclear efficacy)- Bedaquiline, clarithromycin, clofazimine,
    linezolid, amoxiclav, imipenem/cilastatin.
    ( group v drugs are reserved for XDR-TB)
    CLASSIFICATION BASED ON SENSITIVITY

    Drug sensitive TB- Sensitive all first line drugs.

    MDR-TB- Resistant to both INH and R with or with out resistant to other
    first line drugs.

    XDR-TB- A MDR-TB case with resistant to 1 FQ and one injectable.


    TREATMENT- DRUG SENSITIVE TB

    The 6-month regimen with pyrazinamide can probably be used safely during pregnancy and is recommended by the WHO
    and the International Union Against Tuberculosis and Lung Disease.

    If pyrazinamide is not included in the initial treatment regimen, the minimal duration of therapy is 9 months
    TREATMENT- DRUG SENSITIVE TB- ACCORDING TO RNTCP

    SAME AS WHO- ETHAMBUTAL ADDED IN CONTINUTION PHASE ( 4HRE)

    BODY WEIGHT HRZE (tab a) HRE ( tab b)


    25-39KG 2 2
    40-54 kg 3 3
    55-69kg 4 4
    > Or = 70 5 5
    Tab a – H(75mg)+R(150mg)+Z(400mg)+E(275mg).
    Tab b – H(75mg)+ R(150mg)+ E( 275mg).
    RX - MDR

    • MDR-TB has a most rapid course with worse outcome.


    Treatment is for longer duration and expensive.
    In India 3% of all new cases and 12-17% of retreatment cases.
    STANDARD RNTCP REGIMEN FOR MDR-TB BASED ON WHO
    RECOMMENDATIONS.
    INTENSIVE PHASE( 6-9 months) CONTINUTION PHASE(18months)
    1) Kanamycin 1) Levofloxacin
    2) Levofloxacin 2) Ethionamide
    3) Ethionamide 3) Cycloserine
    4) Cycloserine 4) Ethambutol
    5) Pyrazinamide
    6) Ethambbutal

    + PYRIDOXIN 100mg /day


    RIFAMPIN RESISTANT-TB

    According to RNTCP and WHO RR-TB should be treated as MDR- TB


    MONODRUG RESISTANT TB

    •R
    • + 2 FIRST LINE DRUGS TO WHICH BACILLI ARE SENSITIVE
    • + 1 INJECTABLE SECOND LINE
    • + 1 FQ

    A Total of 5 drugs with intensive phase of 3-6 months. With total duration
    of treatment for 9-12 months.
    Polydrug resistant tb

    •R
    • + 1 FIRST LINE DRUGS TO WHICH BACILLI ARE SENSITIVE
    • + 1 second line drug
    • + 1 INJECTABLE SECOND LINE
    • + 1 FQ

    A Total of 5 drugs with intensive phase of 3-6 months. With total duration
    of treatment for 9-12 months.
    ISONIAZID RESISTANT TB

    inhA --- 900 mg/day for a person of 46-70kg


    Kat G
    EXTENSIVE DRUG RESISTANT TB

    Resistant to at least 4 most effective cidal Drugs –


    viz- H,R,FQ and one of Km/Am/Cm
    Treatment include 7 drugs in intensive phase ( 6-12 months)
    6 drugs in continuation phase (18 months)
    Daily doses for 46-70 kg body weight
    Capreomycin – 1000mg
    Moxifloxacin 400 mg
    PAS – 12 G
    Clofazimine – 200mg
    Linezolid 600mg
    Amoxi-clav (875+125) – 2 caps in morning + 1 cap in evening.
    THANK YOU

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