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Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE
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Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE

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Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE

Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2006 UPDATE

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  • 1. Clinical Practice Guidelines for the Diagnosis,Treatment, Prevention and Control ofTuberculosis in Adult Filipinos: 2006 UPDATE i
  • 2. Participating Societies and Agencies:Philippine Society for Microbiology and Infectious Diseases(PSMID)Philippine College of Chest Physicians(PCCP)Philippine Coalition Against Tuberculosis(PhilCAT)Philippine College of Physicians(PCP)Philippine College of Radiology(PCR)Philippine Academy of Family Physicians(PAFP)Philippine College of Occupational Medicine(PCOM)Department of Health(DOH) ii
  • 3. Voting Panelists: Manolito Chua, M.D. Noel Macalalad, M.D. Philippine Society for Microbiology and Infectious Diseases Rodolfo Tamse, M.D Gaudeliza Tan, M.D. Raoul Villarete, M.D. Philippine College of Chest Physicians Jubert Benedicto, M.D. Ma. Imelda Quelapio, M.D. Jennifer Ann Wi, M.D. Philippine Coalition Against Tuberculosis Charles Yu, M.D. Philippine College of Physicians Sarah Zampaga, M.D. Anthony Alvarez, M.D. Philippine College of Radiology Policarpio Joves, M.D. Philippine Academy of Family Physicians Rufo Aranjuez, M.D. Marilyn Alentajan, M.D. Marilou Renales, M.D. Philippine College of Occupational Medicine Rosalind Vianzon, M.D. Department of Health iii
  • 4. Task Force for Tuberculosis 2006 UpdateChairpersons:Regina P. Berba M.D.Vincent M. Balanag M.D.Technical Working Committee Lead Persons:Diagnosis: Regina P. Berba M.D.Treatment: Marissa M. Alejandria M.D.Burden of Illness/Control and Prevention: Mario M. Panaligan M.D.Technical Working Committee Members:DIAGNOSIS:Jubert Benedicto, M.D. (PhilCAT)Teresa Benedicto, M.D. (PCR)Regina Berba, M.D. (PSMID)Paolo de Castro, M.D. (PAFP)Mitzi Marie Montebon Chua, M.D. (PSMID)Eleanor Dominguez, M.D. (PCCP)Celine Garfin, M.D. (DOH)Rodolfo Pagkatipunan, M.D. (PCCP)Rontgene Solante, M.D. (PSMID)Larissa Lara Torno, M.D. (PSMID)TREATMENT:Marissa M. Alejandria M.D. (PSMID)Vincent M. Balanag, Jr., M.D. (PCCP)Charity Ann Ypil Butac, M.D.Vivian Lofranco, M.D. (DOH)Maria Sonia Salamat, M.D. (PSMID)Cherry Taguiang-Abu, M.D. (PSMID)Primo Valenzuela, M.D. (PSMID)CONTROL AND PREVENTION:Maria Rhona Bergatin, M.D. (PSMID)Pio Esguerra II, M.D. (PCCP)Josefina Isidro, M.D. (PAFP)Sheila Laviňa, M.D. (PAFP)Regie Layug, M.D. (PAFP)Lalaine Mortera, M.D. (PhilCAT)Mario Panaligan, M.D. (PSMID)Rosalind Vianzon, M.D. (DOH)Leander Simpao, M.D. (PMS) iv
  • 5. STEERING COMMITTEERenato B. Dantes M.D., President, PCCPJaime C. Montoya M.D., Professor, UP College of MedicineIsabelita Samaniego M.D., Chairperson, Dept. Of Family & Comm Medicine, OMMCJaime Lagahid M.D., Director IV-DOHADVISORY COMMITTEEThelma Tupasi, M.D., President, Tropical Disease FoundationFelix Barrera, M.D., Visiting Consultant, QI Medical CenterDomingo Bongala, M.D., Consultant, Dept. of Surgery, UERMMCEvelina Lagamayo, M.D., Immediate Past President, PSMIDCatherine Lazaro, M.D., Immediate Past President, PCRMariquita Mantala, M.D., Former Director IV, NCDPC-DOHMyrna Mendoza, M.D., Head, Dept. Of Medicine, NKTIReynaldo Olazo, M.D., Immediate Past President, PAFPMarilyn Ong-Mateo, M.D., Immediate Past President, PCCPAdrian Pena, M.D., Professor and Chief, Section of Infectious Disesess, UERMMMCCamilo Roa, M.D., Professor-UP College of MedicineOscar Tinio, M.D., President, PCOMMadeleine Valera, M.D., Director, PhilHealthJeniifer M. Wi, M.D., Past President, PCCPCharles Y. Yu, M.D., Secretary Philippine Specialty Board of Internal MedicineCONSENSUS GROUPEvelyn Alesna, M.D.Donna Jean Aninon, M.D.Teresita Aguino, M.D.Abundio Balgos, M.D.Celerina Barba, M.D.Ernesto Bontoyan, M.D.Elizabeth Cadena, M.D.Margarita Cayco, M.D.Ferdinand Gerodias, M.D.Jude Guiang, M.D.Ludovico Jurao, M.D.Jodor Lim, M.D.Melvin Magno, M.D.Vegloure Maguinsay, M.D.Ma. Consuelo Obillo, M.D.Tom Polloso, M.D.Albert Santos, M.D.Dietmer Schug, M.D.Rodolfo Tamse, M.D.Melecia A. Velmonte, M.D.Raoul Villarete, M.D.Lita Vizconde, M.D. v
  • 6. EXTERNAL REVIEWERSMary Ann Lansang, M.D., Professor of Medicine & Clinical Epidemiology UPCMFermin Manalo, M.D., Founding President, PCCPMichael Voniatis, M.D., Medical Officer, Stop TB & Leprosy Elimination, WHO-DOHMita Pardo de Tavera, M.D., Chairman, Alay Kapwa ng Kilusan Pangkalusugan vi
  • 7. EXECUTIVE SUMMARYThis document updates the previous Philippine Clinical Practice Guidelines on theDiagnosis, Treatment and Control of Pulmonary Tuberculosis 1 released in the year 2000.It is written for all physicians and other healthcare professionals of various specialtiesand should be helpful in the various settings of clinical practice- whether private, public,mixed, hospital, institutional and so on. The scope of this Clinical Practice Guidelines(CPG) was broadened to include key issues in the management of tuberculosis (TB) andwas not limited to pulmonary TB (PTB).Rationale Behind the 2006 TB Update: Updated recommendations and evidence will further strengthen the National Tuberculosis Program (NTP) of the Department of Health (DOH). Updated reports will showcase the positive results and benefits of managing all TB patients through the globally-endorsed strategy of Directly-Observed Therapy, Short Course (DOTS) as experienced in the Philippines. Updated commitment of the professional societies will be an engine to merge efforts of the private practitioners into the government infrastructure of the NTP. Updated information will empower all health practitioners in the Philippines so that they can manage TB using best practices and allow them to contribute towards worldwide and national TB targets. Updated information will be in line with the International Standards for Tuberculosis Care (ISTC) 2Consensus Development. The literature reviewed by the technical committees includedforeign and local data from 1998 to 2005. The consensus statements in the full documentwere developed through a series of discussions reviewing updated evidence andexperience among the technical committees, advisory committee members and therepresentatives of the different professional societies. A Technical Review Panel wasformed consisting of voting representatives of each of the professional societies andagencies. For each and every statement of recommendation, a consensus was reachedwhen there was at least 75% agreement within the Technical Review Panel.Each statement carries a grading as follows: Grade A- The recommendation is based onstrong evidence and comes from at least one study at Level 1 evidence or is a welldesigned randomized controlled trial or a meta-analysis. Grade B- The recommendationis based on moderately strong evidence and comes from at least a study at Level 2evidence; Grade C- The best evidence available may be a study at Level 3 or lower; ormay be expert opinion.1 Task Force on Tuberculosis, Philippine Practice Guideline Group in Infectious Diseases. The PhilippineClinical Practice Guidelines on the Diagnosis, Treatment and Control of Pulmonary Tuberculosis Vol 1No. 3 Quezon City Philippines: PPGG-IDS Philippine Society of Microbiology and Infectious Diseases andPhilippine College of Chest Physicians, 2000.2 Tuberculosis Coalition for Technical Assistance. International Standards of Tuberculosis Care. TheHague: Tuberculosis Coalition for Technical Assistance 2006. vii
  • 8. The most salient issues are enumerated in this executive summary. The full documentcontains all the fifty-two consensus statements including details and bases ofrecommendations.DIAGNOSIS OF TB • When to suspect PTB. In the Philippines, cough of two weeks or more should make the physician and/or other healthcare workers suspect the possibility of PTB [Grade A Recommendation]. Cough with or without the following: night sweats, weight loss, anorexia, unexplained fever and chills, chest pain, fatigue and body malaise is suggestive of PTB. • Recommended initial work-up when suspecting PTB. The initial work-up of choice for PTB is sputum microscopy for acid fast bacilli (or sputum AFB). All patients who present with cough of two weeks or more should preferably have three, but at the least two sputum specimens sent for sputum AFB [Grade A]. Sputum microscopy is still the most efficient way of identifying cases of PTB. Sputum AFB is available, accessible, and affordable, with results rapidly available. It also correlates well with infectiousness. • When to order sputum TB culture in addition to sputum microscopy. In the Philippines, where resources are limited and the laboratory capability for sputum culture is still being strengthened, sputum TB culture with drug susceptibility testing (DST) is primarily recommended for patients who are at risk for drug resistance. Sputum TB culture is recommended in the following smear positive patients: All cases of retreatment [Grade A Recommendation] All cases of treatment failure [Grade A] All other cases of smear positive patients suspected to have one or multi- drug resistant TB (MDR-TB) [Grade A]. All household contacts of patients with MDR- TB [Grade C]. In patients who may be infected with the Human Immunodeficiency Virus (HIV) [Grade A] Sputum TB culture is recommended for all smear negative patients, whenever resources permit, with additional DST for patients at risk for drug resistance [Grade A]. • Follow-up work-up when initial sputum AFB is negative. For the patients suspected to have PTB whose sputum smears are negative, the following tests and procedures are recommended: 1) Chest radiograph; 2) TB culture when available with DST if at risk for drug resistance; and 3) repeat sputum AFB after an adequate nebulization procedure if there is doubt on quality of sputum. viii
  • 9. • Patients coming with chest radiographs suggestive of PTB. Physicians and patients must be discouraged from initiating treatment for TB based on chest radiographs alone. An adult patient consulting with a chest radiograph suggestive of PTB should undergo sputum microscopy regardless of symptoms and follow a similar flow of diagnostic work-up as the TB symptomatic. • Extrapulmonary TB. The diagnosis of extrapulmonary TB initially depends on the physician having a high degree of suspicion of TB in a patient at risk. For all patients suspected of having extrapulmonary TB, appropriate specimens from the suspected sites of involvement should be obtained and processed for microbiologic, both microscopy and culture, as well as histopathologic examinations. Sputum should likewise be sent for microbiologic studies.TREATMENT OF TB • DOTS for all patients. All treatment regimens mentioned below should be administered under directly observed therapy (DOT) for the total duration of the treatment, within the context of a DOTS program [Grade A]. • Newly diagnosed Smear Positive PTB. The recommended treatment regimen for all adults newly diagnosed with smear-positive tuberculosis and no history of treatment is a short-course chemotherapy (SCC) regimen, consisting of two months of isoniazid, rifampicin, pyrazinamide and ethambutol (2HRZE) in the initial phase, and 4 months of isoniazid and rifampicin (4HR) in the continuation phase [Grade A]. The initial phase of treatment (2HRZE) should be given daily, followed by daily or thrice-weekly administration of isoniazid and rifampicin during the continuation phase. • Newly diagnosed Smear Negative PTB. In the Philippines where INH resistance is high, a short-course chemotherapy regimen consisting of 2HRZE/4HR is recommended for smear-negative PTB patients who are either without HIV or with an unknown HIV status [Grade C]. • Relapse cases of PTB. Relapse is defined as a patient previously treated with one full course of chemotherapy under DOT who has been declared cured or treatment completed and has become smear-positive for TB again. For these patients, re- treatment using the two months of five-drug regimen: isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin, followed by one month of the HRZE and 5 months of HRE or (2HRZES/1HRZE/5HRE) is recommended. Observational studies have shown that relapses after a previous SCC regimen given under DOT have the same drug susceptibilities as the initial treatment isolates. [Grade B] • Symptomatic patients who were not on DOTS in the previous treatment. For persistently symptomatic patients who received non-supervised self-administered therapy or used regimens that did not contain rifampicin, the risk of acquired drug resistance is high. TB culture with DST should be done. The 2HRZES/ ix
  • 10. 1HR1ZE/5HRE regimen can be given pending susceptibility results.[Grade B] • Treatment failure is considered when a patient remains smear positive towards the end of treatment, or after completion of the SCC under DOT. Sputum culture and DST should be done because treatment failure after SCC given under DOT is a strong indication of MDR-TB. The re-treatment regimen (2HRZES/1HRZE/5HRE) may be given after specimens for culture and DST are obtained, although failure rates with this regimen are quite high [Grade C]. Considering the complexity of the treatment of these patients and the significant amount of resources required, it is recommended that treatment failures be managed under the Programmatic MDR-TB Management (PMTM) program (previously referred to as the DOTS Plus). Pending integration of the PMTM program into the NTP, these patients should be referred to the NTP TB regional coordinator for appropriate action. • MDR-TB suspects. Drug-resistant tuberculosis is suspected in the following situations: when a smear-positive patient does not respond to the standard WHO re-treatment regimen especially if the treatment was given under DOT; when a patient continues to have positive sputum smears after 2 months of SCC under DOT; when a patient has had a history of close or long-term exposure to a person with documented resistance to anti-TB drugs, or to a person with prior history of treatment whose susceptibility test results are not known Immediate referral of patients with suspected MDR-TB to specialized treatment centers under the Programmatic MDR-TB Management (PMTM) is recommended. [Grade C]. Treating MDRTB empirically, especially with fluoroquinolones, is not recommended [Grade C].CONTROL AND PREVENTION OF TB • DOTS a must for all patients. All treatment regimens should be administered under directly observed treatment (DOT), within the context of a DOTS program [Grade A]. • Other effective ways of monitoring and improving adherence to TB treatment include: repeated home visits, reminder letters, cash incentives, health education by nurses, and the use of community health advisers. These measures should be done utilizing the DOT strategy, preferably under a DOTS program [Grade C]. • Contact Tracing. As an extension of the WHO DOTS strategy, targeted contact tracing among family members and close contacts of patients with tuberculosis can facilitate reduction in the morbidity and mortality attributed to the disease [Grade C]. • Latent TB. At this time, the treatment of patients with latent TB infection is not a priority in the Philippines. Resources are focused on the “source” case. If and when targets to control TB have been achieved and sustained, strategies can then be shifted from control to elimination. [Grade C]. x
  • 11. • Vaccination for TB. Bacille bilié de Calmette-Guérin (BCG) vaccination is not recommended for adults because it does not confer protection. [Grade C]. There is currently no available effective vaccine against tuberculosis but several trials are underway.MAJOR ADDITIONS OF2006 UPDATE to the 2000 TB CPG 2006 Update 2000 TB ConsensusTo diagnose PTB: To diagnose PTB:Preferably three, but at least 2 sputum At least three sputum specimens should bespecimens should be submitted for AFB submitted for AFBDefinition of Smear Positive: Definition of Smear Positive:At least 2 specimens are AFB positive In areas where quality assurance policies are routine, at least one AFB positive; in other areas, at least 2 AFB smears positiveRole of the TB Diagnostic Committtee TBDC not yet introduced(TBDC): to evaluate chest radiographsamong smear-negative casesRecommended treatment regimen for new Recommended treatment regimen for newcases: 4-drug regimen for new TB cases cases: A minimum of 3-drug regimen for new TB casesRecommended treatment regimen for re- Recommended treatment regimen for re-treatment cases: 2HRZES/1HRZE/5HRE treatment cases: No fixed regimeninitially recommended for re-treatment recommended for re-treatment casescasesRecommendation for suspected MDR-TB: Recommendation for suspected MDR-TB:Empiric treatment with various anti-TB Recommended empiric treatment usingdrugs is not recommended for suspected second line anti-TB drugs for suspectedMDR-TB cases. Instead immediate referral MDRTB cases.to PMTM program is highly encouraged.Preferred mode of administration of anti- Preferred mode of administration of anti-TB drugs: TB drugs:Fixed-dose combinations (FDC) are No mention yetrecommended for new casesDOT treatment partners: No mention yetLay health workers, volunteers, familymembersAlternative treatment regimens: Alternative treatment regimens: DailyThrice weekly regimen also recommended regimens only mentionedRole of adjunctive therapy in TB: Arginine, Role of adjunctive therapy in TB: Novitamin A and zinc recommended as clear benefits for any adjunctive therapyadjunctive therapy xi
  • 12. Table of ContentsAcknowledgments…………………………………………… ii-viExecutive Summary…………………………………………… vii-xiList of Tables…………………………………………………… xiiiList of Boxes…………………………………………………… xivList of Figures………………………………………………...... xivList of Abbreviations and Acronyms…………………………. xvChapter 1:Introduction………….……………………………………….... 1-4Chapter 2:Current State of Tuberculosis in the Philippines……………. 5-28 References for Chapter on Current State of TB……………………. 26-28Chapter 3:Diagnosis of Tuberculosis in Adult Filipinos………………… 29-60 References for Chapter on Diagnosis ……………………………... 57-60Chapter 4:Treatment of Tuberculosis in Adult Filipino……………….. 61-121 References for Chapter on Treatment……………………………… 114-121Chapter 5:Control and Prevention of Tuberculosis in the Philippines … 121-128 References for Chapter on Control……………………………….. 128Chapter 6: Algorithms………………………………………… 129-133 xii
  • 13. List of TablesTable I: Summary Table of Studies of Private Physicians and their Adherence to the WHO-NTP Standards on the Diagnosis and Treatment of Tuberculosis…………………………………… 14Table II: Categories of TB cases according to Previous Treatment Received by the Patient……………………………………… 29Table III: Terminology of TB from the ATS (old) and WHO (new)….. 30Table IV: Summary Table of Studies on Sputum Microscopy 1998 – 2004 33Table V: Summary Table of Studies comparing the Diagnostic Sensitivity Rates using Induced Sputum (IS) with Bronchoscopic specimens (BS) ………………………………………………………… 36Table VI: Traditional and New Radiologic Terms related to Tuberculosis 42Table VII: Performance of Serologic Tests for TB showing Extrapolated Positive and Negative Predictive Values (PPV and NPV) assuming a Local Prevalence of 42/1000 Population…………………… 48Table VIII: The Characteristics of TB Infection and Disease in Relation to the Stages of HIV Infection………………………………………. 52Table IX: Summary Table of Studies on the Yield of AFB smear of Sputum in HIV versus non-HIV patients………………….. 52Table X: Diagnostic Yield of Clinical Specimens from HIV-Infected Patients With Tuberculosis Comparing microscopy with Culture……………………………………………………….. 56Table XI. Summary of results of the clinical trial of short-course regimens 64Table XII. Summary Table of Studies on Sensitivity Patterns of Re-treatment Cases after Failure of Initial Treatment, 1997 – 2005………… 73Table XIII. Summary Table of Studies on Clinical Results of Re-treatment… 73 xiii
  • 14. Table XIV. Summary Table of Observational Studies on MDR-TB………… 79Table XV. Summary of outcomes of FDC vs. SDF studies ………………… 88Table XVI. Summary of outcomes of FDC vs. SDF studies ………………… 88Table XVII. Summary of FDC vs. SDF studies (Other Drug Reactions)……… 88Table XVIII. Dosing recommendations for adult patients with reduced renal function and for adult patients receiving hemodialysis…………… 100Table XIX. Treatment duration for extrapulmonary TB………………………. 103Table XX. Adjunctive Treatment for Extrapulmonary TB…………………… 104 List of FiguresFigure 1. Case Detection Rates of All Private-Public Mix DOTS Centers 2001-2004………………………………………………………. 20 List of BoxesBox 1: Rationale Behind 2006 Update of Philippine Clinical Practice Guidelines for Tuberculosis……………………………………… 2Box 2: Historical Points of Tuberculosis Control in the Philippines 1910-1950……………………………………………………….. 8Box 3: Historical Points of Tuberculosis Control in the Philippines 1950-1990s……………………………………………………….. 9Box 4: Historical Points in Tuberculosis Control in the Philippines 1990- 2000s………………………………………………………. 10Box 5: Historical Points in Tuberculosis Control in the Philippines 2001 to Present……………………………………………………. 11 xiv
  • 15. List of Abbreviations and Acronyms AFB Acid fast bacilli AIDS Acquired immunodeficiency syndrome AMTD Amplified Mycobacterium tuberculosis Direct Test APMC Association of Private Medical Colleges ARV Anti-retroviral ATS American Thoracic Society BCG Bacille bilie de Calmette-Guerin BMRC British Medical Research Council BS Bronchoscopic specimens CDC Centers for Disease Control and Prevention CDR Case detection rate CHD Center for Health Development CHW Community health worker CI Confidence interval CPG Clinical Practice Guideline CSF Cerebrospinal fluid CT Computerized tomogram CUP Comprehensive Unified Policy CXR Chest radiograph DALY Disability-adjusted life years DILG Department of Interior and Local Government DOH Department of Health DOR Diagnostic Odds ratio DOT Directly Observed Treatment DOTS Directly Observed Therapy, Short Course DRS Drug resistance surveillance DST Drug susceptibility testing DT Daily therapy E Ethambutol ELISA Enzyme-linked immunosorbent assay EPI Expanded Program for Immunization EPTB Extrapulmonary tuberculosis ER Emergency room FDC Fixed-dose combination FNAC Fine-needle aspiration cytology GDF Global Drug Fund GFATM Global Fund Against Tuberculosis and Malaria H Isoniazid HIV Human immunodeficiency virus HMO Health maintenance organization HRCT High-resolution computerized tomogram HSRA Health Sector Research Agenda xv
  • 16. IDSA Infectious Diseases Society of AmericaIS Induced sputumISTC International Standards for Tuberculosis CareIUATLD International Union Against Tuberculosis and Lung DiseaseKAP Knowledge, attitude, practiceLEAD Local Enhancement and DevelopmentLFT Liver function testLGU Local government unitMDR-TB Multi-drug resistant tuberculosisMOTT Mycobacterium Other Than TuberculosisMOP Manual of ProcedureNAA Nucleic acid amplificationNIT National Institute of TuberculosisNPV Negative predictive valueNPS National Prevalence SurveyNTP National Tuberculosis ProgramNTRL National Tuberculosis Reference LaboratoryOPD Outpatient departmentOR Odds RatioPAS Para-amino salicylatePAFP Philippine Academy of Family PhysiciansPCCP Philippine College of Chest PhysiciansPCOM Philippine College of Occupational MedicinePCP Philippine College of PhysiciansPCR Philippine College of RadiologyPCSO Philippine Charity Sweepstakes OfficePhP Philippine pesoPhilCAT Philippine Coalition Against TuberculosisPhilHealth Philippine Health Insurance CorporationPhilTIPS Philippine Tuberculosis Initiative in the Private SectorPMTM Programmatic MDR-TB ManagementPPD Purified protein derivativePPMD Private-public mix DOTSPPS Philippine Pediatric SocietyPPV Positive predictive valuePSMID Philippine Society for Microbiology and Infectious DiseasesPTB Pulmonary tuberculosisPTSI Philippine Tuberculosis Society Inc.R RifampicinRHU Rural health unitS StreptomycinSCC Short-course chemotherapy xvi
  • 17. SDF Single drug formulationTB TuberculosisTBDC TB Diagnostic CommitteeTDFI Tropical Disease Foundation Inc.TST Tuberculin skin testingTWC Technical Working CommitteeTWT Thrice weekly therapyVAS Visual Analogue ScaleWHO World Health OrganizationZ Pyrazinamide2HRZE 2 months of combination of isoniazid, rifampicin, pyrazinamide and ethambutol2HRZES 2 months of combination of isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin4HR 4 months of isoniazid and rifampicin xvii

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