Ntep India recent changes in brief

1. RECENT TB TREATMENT
GUIDELINES
(in brief)
By Dr Saiel Kumarjuvekar
JR3 Orthopaedics
BJGMC & SGH ,PUNE

2. • RNTCP= REVISED NATIONAL TB CONTROL PROGRAMME
CHANGED TO
NTEP= NATIONAL TB ELIMINATION PROGRAMME (JAN 2020)

3. Changes
• drug sensitivity checking
• daily regimen
• fixed dose combinations
• weight band introduction
• no cat II
• ethambutol in cat I Continuation phase

4. • group A
TB Prevention
• group B
all TB Patients

5. A - TB prevention
• for suspects , house hold contacts, immunosuppresed, on dialysis.
• drugs : isoniazid daily for 6 months or isoniazid + Rifapentine for 3
months weekly

7. B- All TB patients
TB confirmed Patient
NAAT
Rifampicin Resistance Rifampicin Sensitive
DS Regimen
drug senstive regimen
Isoniazid Resistance
H resistant mono/poly regimen
Line Probe Assay
only Rifampicin resistance rifampicin
+ other drug
resistant
shorter oral
bedaquiline MDR/RR TB
Regimen
Longer Oral
MDR/RR TB

8. DRUG SENSITIVE REGIMEN
• 6 MONTHS TOTAL
• 2 MONTH INTENSIVE PHASE
• 4 MONTHS CONTINUOUS
• DAILY DOSAGE
• FDC
INTENSIVE PHASE 2 MONTHS CONTINUATION PHASE 4 MONTHS
HRZE HRE

9. WEIGHT BANDS
WEIGHT CATEGORY NNUMBER OF TABLETS FDC
INTENSIVE PHASE HRZE
(75/150/400/275)
CONTINUATION PHASE HRE
(75/150/275)
25-34 2 2
35-49 3 3
50-64 4 4
65-75 5 5
>76KGS 6 6

10. DRUG DOSAGES
DRUGS ADULT PEDIATRIC
ISONIAZID 5 mg/kg 10 mg/kg
RIFAMPICIN 10 mg/kg 15mg/kg
PYRAZINAMIDE 25 mg/kg 35 mg/kg
ETHAMBUTOL 15 mg/kg 20 mg/kg

11. ISONIAZID RESISTANT MONO/POLY REGIMEN
• NO PHASES
• 6 MONTHS
• CAN BE EXTENDED TO 9 MONTHS
• DRUGS : LFx/LEVOFLOXACIN
R/RIFAMPICIN
Z/PYRAZINAMIDE
E/ ETHAMBUTOL

12. SHORTER ORAL BEDAQUILINE MDR/RR TB
REGIMEN
• INTENSIVE PHASE 4-6 MONTHS
• CONTINUATION PHASE 5 MONTHS
• BEDAQUILINE GIVEN FOR 6 MONTHS
• TOTAL DURATION OF 9-11 MONTHS (< YEAR)
INTENSIVE PHASE 4-6M CONTINUATION PHASE 5 MONTHS
Bdq/BEDAQUILINE(6months)
Mfx/MOXIFLOXACINE
Cfz/CLOFAZIMINE
E/ETHMABUTOL
H/ISONIAZID
Z/ PYRAZINAMIDE
Eto/ETHIONAMIDE
MOXIFLOXACIN
CLOFAZIMINE
PYRAZINAMIDE
ETHAMBUTOL

13. LONGER ORAL M/XDR TB REGIMEN <2YEARS
• 18-20 MONTHS
• BEDAQUILINE FOR 6 MONTHS
• LINEZOLID DOSE TAPPERING TO 300mg AFTER 8 MONTHS
Lfx/ LEVOFLOXACIN , Bdq(6m)/
BEDAQUILINE, Lzd/ LINEZOLID,
Cfz/CLOFAZIMINE, Cs/CYCLOSERINE

14. Thank you