5th VS 6th TB Guideline

1. 5th VS 6th
TB Guideline
D R . M D . S H A F I Q U L I S L A M D E WA N
R E S I D E N T ( P U L M O N O L O G Y )
R E S P I R A T O R Y M E D I C I N E D E P A R T M E N T
D H A K A M E D I C A L C O L L E G E H O S P I T A L

2. Changes in 6th edition
Change in History
Change in Classification
Diagnostic Algorithm
Change in Treatment
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 2

3. History & Recommendation
5TH EDITION
Sputum microscopy for AFB should
always be requested for patient who
has cough for three weeks or longer
even in the absence of any other
symptoms.
6TH EDITION
GeneXpert or Sputum microscopy for
AFB should always be requested for
patient who has cough for two weeks
or longer even in the absence of any
other symptoms.
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 3

4. Classification of TB patient
5TH EDITION
Smear positive PTB
Smear Negative PTB
Extra-pulmonary TB
TB/HIV co-infection
6TH EDITION
Bacteriologically positive PTB
Bacteriologically negative PTB
Clinically diagnosed PTB
Extra-pulmonary TB
Complicated EP cases
TB/HIV co-infected
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 4

5. DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 5
5th
Edition

6. DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 6
6th
Edition
Changed
After sputum
positive tested by
GeneXpert if
available

7. Standardized treatment regimen for each diagnostic category (adults)
NATIONAL GUIDELINE AND OPERATIONAL MANUAL FOR TUBERCULOSIS, 5TH EDITION 7
5th
Edition

8. Standardized treatment regimen for each diagnostic category (adults)
NATIONAL GUIDELINE AND OPERATIONAL MANUAL FOR TUBERCULOSIS, 6TH EDITION 8
6th
Edition

9. New Cases ( Category-1) Drugs
CATEGORY 1 (5TH EDITION)
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
CATEGORY 1 (6TH EDITION)
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 9
5th vs 6th
No
Changed

10. New Cases ( Category 1) Duration
CATEGORY 1 (5TH EDITION)
Total: 6 months
 Intensive Phase (IP): 2 months
 Continuation Phase (CP): 4 months
Drugs
 Intensive Phase (IP): 2HRZE
 Continuation Phase (CP): 4 HR
CATEGORY 1 (6TH EDITION)
Total: 6 months
 Intensive Phase (IP): 2 months
 Continuation Phase (CP): 4 months
 12 months: 2/10(TB meningitis,
Neurological TB, Bone TB, non-resolving
lymph node) [changed]
Drugs
 Intensive Phase (IP): 2HRZE
 Continuation Phase (CP): 4 HR/10HR
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 10
Changed
Duration
12 months
in EPTB

11. Previously Treated Cases (Category-2)
CATEGORY 2 (5TH EDITION)
1) Isoniazid
2) Rifampicin
3) Pyrazinamide
4) Ethambutol
5) Streptomycin (IV)
CATEGORY 2 (6TH EDITION)
1) Isoniazid
2) Rifampicin
3) Pyrazinamide
4) Ethambutol
5) Levofloxacin (oral)
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 11
5th vs 6th
Changed
Drugs

12. Previously Treated Cases (Category-2)
CATEGORY 2 (5TH EDITION)
Total: 8 months
 Intensive Phase (IP): 3 months
 Continuation Phase (CP): 5 months
Drugs
 Intensive Phase (IP): 2(HRZE)S/1(HRZE)
 Continuation Phase (CP): 5(HRE)
CATEGORY 2 (6TH EDITION)
Total: 6 or 12 months
 6 months regimen
 12 months regimen
Drugs
 6 months regimen: 6(HRZE) or 6(HRZE)-Lfx
 12 months regimen: 12(HRZE) or 12(HRZE)-Lfx
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 12
5th vs 6th
Changed
Duration

13. If DST of Rifampicin and isoniazid possible
If the DST results show that the patient is susceptible to both rifampicin and
isoniazid
All bacteriologically confirmed previously treated pulmonary as well as extra-
pulmonary TB patients will be given Cat.1 regimen i.e., 2EHRZ/4HR.
**The treatment may be extended in certain forms of EP-TB like CNS TB, Skeletal
TB, Disseminated TB etc. based on clinical decision of the treating physician on a
case-to-case basis.
DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 13

14. Doses Guidelines
NATIONAL GUIDELINE AND OPERATIONAL MANUAL FOR TUBERCULOSIS, 6TH EDITION 14
6th
Edition
Changed
New drug
Lfx

15. Schedule for follow-up sputum examination in pulmonary
bacteriologically confirmed TB patients
NATIONAL GUIDELINE AND OPERATIONAL MANUAL FOR TUBERCULOSIS, 6TH EDITION 15
6th
Edition
No
Changed

16. First-line anti-TB drugs
NATIONAL GUIDELINE AND OPERATIONAL MANUAL FOR TUBERCULOSIS, 6TH EDITION 16
6th
Edition

17. Second-line anti-TB drugs
NATIONAL GUIDELINE AND OPERATIONAL MANUAL FOR TUBERCULOSIS, 6TH EDITION 17
6th
Edition

18. DR. MD. SHAFIQUL ISLAM DEWAN, RESIDENT (PULMONOLOGY), DMCH 18
Thank You