From the introduction of new diagnosing technique Gene Xpert , diagnosing & treating TB has been a lot easier. So Nepal Govt. has adapted few changes in past t/t. This slide consists of slides on new case as well as MDR t/t.

1. NATIONAL TB PROGRAM, NEPAL
TB REGIMEN
ANNUAL REPORT 2074/2075
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2. Type of TB Intensive Phase Continuation Phase
New TB Cases
All forms:
- Adult & childhood
- Bacteriological or clinically
diagnosed
- pulmonary or extra-pulmonary
2 HRZE 4HR
New TB (severe cases)
All forms:
E.g. CNS TB, Musculoskeletal TB,
Miliary TB
2HRZE 7 HRE with the possibility of 3
HRE in the end
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3. For all the retreatment cases
• Xpert MTB/Rif test or CB-NAAT (cartridge based nucleic acid
amplification test):
>detect bacilli and resistance to Rif , within 2 hours.
>This test is done to see the status of resistance to Rifampicin
followed by line probe assay (LPA) among those having MTB +ve and
Rifampicin sensitive for Isoniazid resistance status.
ATT drug that goes resistance fastest is Isonoazid.
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4. Xpert MTB/ Rif
Rifampicin sensitive
LPA- isoniazid sensitive
2 HRZE 4 HR
Rifampicin sensitive
LPA –isoniazid resistant
6 HRZE + Levofloxacin (full duration)
Rifampicin sensitive
LPA –isoniazid not done because of no
access to LPA
6 HRZE (full duration)
All patients with TB meningitis and TB pericarditis will also receive steroids in addition to TB t/t.
NTP no longer recommends category II which includes streptomycin to be used and officially
phased out category II regimen
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5. MDR-TB t/t Regimen
Kanamycin Km
Moxifloxacin / levofloxacin Mfx / Lfx
Ethionamide Eto
Clofazimine Cfz
Pyrazinimide Z
Ethambutol E
Cycloserine Cs
For t/t of MDR regimen, NTP has also initiated a shorter MDR t/t regimen as
well as conventional longer regimen.
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6. Z
E
Cs
O
Km
Eto
Z
Cs
O
Eto
1ST LINE
2ND LINE
6 months 12 months
Conventional
MDR TB t/t
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7. Z
E
Cfz
O
K
Eto
Z
E
Cfz
O
4-6
months
5
months
1ST LINE
2ND LINE
Shorter MDR
TB t/t Regimen
(STR)
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8. Kanamycin is not to be included in t/t of MDR/RR –TB patients
on longer regimens.
Bedaquiline (Bdq) is a new class drug specifically targeting
mycobacterial ATP synthetase. Is given for 6 months in pre-
XDR and XDR TB t/t regimen.
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