to prevent death from active TB or its late effects;
to prevent relapse of TB;
to decrease transmission of TB to others;
to prevent the development of acquired drug resistance.
DOTS ( Directly observed treatment short course ), Karel Styblo, 1972
The organizational principles of the DOTS are:
availability of a decentralized diagnostic and treatment network based on existing health facilities;
good programme management based on accountability and supervision of health care workers;
an evaluation system of case-finding and cohort analysis of treatment outcomes.
The five elements of the expanded DOTS framework are:
1.Sustained political commitment to increase human and financial resources and make TB control a nationwide priority integral to the national health system.
2. Access to quality-assured TB sputum microscopy for case detection among persons presenting with, or found through screening to have, symptoms of TB (most importantly, prolonged cough).
3. Standardized short-course chemotherapy for all cases of TB under proper case management conditions, including direct observation of treatment.
4. Uninterrupted supply of quality-assured drugs with reliable drug procurement and distribution systems.
5. Recording and reporting system enabling outcome assessment of all patients and assessment of overall programme performance.
Dosage and abbreviation of essential antituberculosis drugs 30 (20-35) 15 (15-20) Ethambutol (E) 15 (12-18) 15 (12-18) Streptomycin (S) 35 (30-40) 25 (20-30) Pyrasinamide (Z) 10 (8-12) 10 (8-12) Rifampicin (R) 10 (8-12) 5 (4-6) Isoniasid (H) 3 times weekly Daily Recommended dosage (dose range) in md/kg Drug (abbreviation)
Basical treatment regimens Optional 5 (HRE) 3 Optional 2(HRZES) 3 /1HRZE 3 Preferred 5 HRE VI Preferred 2 HRZES / 1 HRZE VI Previously treated sputum smearpositive PTB: - relapse; - treatment after default II Optional 4 (HR)3 or 6 HE V Optional or 2 (HRZE) 3 or 2 HRZE IV Preferred 4 HR 4 (HR)3 Preferred 2 HRZE I New smear-positive patients; new smear-negative PTB with extensive parenchymal involvement; concomitant HIV disease or severe forms of extrapulmonary TB I Continual phase Initial phase Treatment regimen I TB patients Diagnostic category
Basical treatment regimens (continued) WHO/CDS/TB/2003.313 Treatment of tuberculosis:guidelines for national programmes, third edition. Revision approved by STAG, June 2004 Specially designed standardized or individualized regimens Chronic (still sputum-positive after supervised re-treatment); proven or suspected MDR TB cases. IV Optional 4 (HR)3 or 6 HE Optional 2 (HRZE)3 Preferred 4 HR Preferred 2 HRZE VIII New smear-negative PTB (other than in category I) and less severe forms of extra-pulmonary TB III Continual phase Initial phase Treatment regimen I TB patients Diagnostic category
MDR-TB prevalence among new cases and countries in which at least one XDR-TB case has been reported At the end of 2006 year XDR-TB has been detected in 17 countries
Extensively drug resistance (XDR) – main definitions
Firstly has been proposed by US Centers of Disease Control and Prevention (CDC) in March, 2006: the disease, caused by MBT, resistant to HR (MDR-TB) and to at least 3 from six classes of antituberculosis second-line drugs (aminoglycosides, polypeptide, fluoquinolones, thyamides, cyclocerine, PAS)
But on WHO meeting devoted to XDR problem (meeting of the WHO XDR-TB Task Force ), on October, 10-11 , 2006 difinition has been changed : the disease, caused by MBT, resistant to HR (MDR-TB) and to at least some fluoquinolones and one from 3 injectional antituberculosis drugs : cyclopentin , kanamycin, amicacin .