Management of tb_regimens

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Management of tb_regimens

  1. 1. Patient wise boxes with multiblister combipack
  2. 2. Phases of TreatmentIntensive Phase• Meant to kill as many bacilli rapidly as possibleContinuation Phase• Aimed to sterilize smaller number of dormant/persistingbacilli to prevent relapse.
  3. 3. • New smear positives• New sputum smear negative• New extra-pulmonary• New othersCategory I(New)Red Box•IP= 2 (HRZE)3•CP=4 (HR)3
  4. 4. Blue Box•IP=2 (HRZES)3+1(HRZE)3•CP= 5 (HRE)3• Smear positive relapse• Smear positive failure• Smear positive treatmentafter default• OthersCategory II(Previouslytreated)
  5. 5. Follow Up• Two sputum smears are examined each time during follow up.1. As early morning sample2. Spot sampleCategory SS –ve at theend of IPSS +ve at theend of IPI 2,4,6th month 2,3,5,7th monthII 3,5,8th month 3,4,6,9th month
  6. 6. 7thmonth6thmonth5thmonth4thmonth3rdmonth2ndmonthAt theendof IPBothSS -vePatientput toCPSS examrepeatedCPcontinuedSS examrepeatedEitherofthem+veIPextendedto 1monthSS +ve/ -vePatientput toCP-ve SSCPcontinuedSS examrepeated+ve SS TreatmentfailureCategoryII
  7. 7. 9thmonth8thmonth6thmonth5thmonth4thmonth3rdmonthAt theend ofIPBoth SS-vePt. putto CPSS examrepeatedContdCPSS examrepeatedEitherof them+veIPextendedto 1monthSS +ve /-vePt. putto CPSS examrepeatedSS examrepeated
  8. 8. Drug ResistancePrimary/ Pre-treatment resistance:• The resistance shown by the bacteria in a patient, whohas not received the drug in question before.• Due to infection by drug resistant bacilli.Secondary / Acquired resistance:• The resistance shown by the bacteria which weresensitive to the drug at the start of the treatment butbecame resistant to the particular drug during thecourse of treatment.
  9. 9. Multi Drug Resistant (MDR) Tuberculosis According to WHO, MDR strain is one that is at leastresistant to Rifampicin and Isoniazid, with or withoutresistance to other anti-TB drugs.CATAGORY IV (DOTS-PLUS)Treatment of MDR-TBIndication:1. History of prior treatment where smear positivecases found even after repeated treatment courses,category II failure.2. Close exposure to possible source cases,confirmed to have drug resistant TB.Diagnosis must be confirmed by culture and DrugSensitivity Testing (DST)
  10. 10. RNTCP RegimenIP= 6(9) Km Ofx Eto Cs Z E + CP= 18 Ofx Eto Cs EExtensively Drug Resistance Tuberculosis• Extensively drug resistance (XDR) is defined as the strainwhich is resistant to:1. at least Rifampicin and INH (i.e. MDR)2. A Fluoroquinolone, and3. one or two following second line injectable drugs:Amikacin, Capreomycin, Kanamycin
  11. 11. Standardized regimen for XDR-TB:Intensive phase:• Capreomycin• PAS• Moxifloxacin• Linezolid• Clofazimine• Amoxicillin/ ClavulinateContinuation phase:• PAS• Moxifloxacin• Isoniazid• Clofazimine• Linezolid• Amoxicillin/ Clavulinate6-12 months18 monthsV
  12. 12. Teratogenic Drugs:Avoidedduring PregnancyAlternative drugs, i.e. Ethambutol must be used instead ofStreptomycin.First line Second lineStreptomycin EthionamideProtionamideFluoroquinolones
  13. 13. Non DOTS RegimenIndication: When there is adverse reaction to drugs used in shortcourse chemotherapy. When patient cannot comply with the DOTS regimen.• New smear positive• Pulmonary seriously ill patients• Extra pulmonary seriously illpatientsNon-DOTS regime1 (ND1):2 (S H E) + 10 (H E)• New smear negative• Pulmonary not seriously ill patients• Extra pulmonary not seriously illpatientsNon-DOTS regime2 (ND2):12 (H E)

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