Management of tb_regimens
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Management of tb_regimens

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Management of tb_regimens Presentation Transcript

  • 1. Patient wise boxes with multiblister combipack
  • 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. • 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. 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. 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. 7thmonth6thmonth5thmonth4thmonth3rdmonth2ndmonthAt theendof IPBothSS -vePatientput toCPSS examrepeatedCPcontinuedSS examrepeatedEitherofthem+veIPextendedto 1monthSS +ve/ -vePatientput toCP-ve SSCPcontinuedSS examrepeated+ve SS TreatmentfailureCategoryII
  • 7. 9thmonth8thmonth6thmonth5thmonth4thmonth3rdmonthAt theend ofIPBoth SS-vePt. putto CPSS examrepeatedContdCPSS examrepeatedEitherof them+veIPextendedto 1monthSS +ve /-vePt. putto CPSS examrepeatedSS examrepeated
  • 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. 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. 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. 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. Teratogenic Drugs:Avoidedduring PregnancyAlternative drugs, i.e. Ethambutol must be used instead ofStreptomycin.First line Second lineStreptomycin EthionamideProtionamideFluoroquinolones
  • 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)