1. Submitted to
Shekhawati College of Pharmacy,Dundlod
Affiliated to Rajasthan University of Health Sciences, Jaipur
In the partial fulfilment of the requirement for
the award of the degree of
BACHELOR OF PHARMACY
Submitted By Supervised By
Manish Joya Mr.Mohit Dhadhich
Enroll. No.(09/17865) M.Pharma
SHEKHAWATI COLLEGE OF PHARMACY, DUNDLOD
2012-13
REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME
(RNTCP)
A Project Report

2. Table contents
Introduction
Basic TB facts
TB drugs & Treatment
Revised the national TB control programme(RNTCP)
Refferences

3.  Introduction
uberculosis (TB) is the single largest infectious
cause of death in the world, accounting for about
500,000 deaths per year in India alone.
 It affects persons during their most productive age.
 India’s National Tuberculosis Programme (NTP) was
established in 1962 and after more than three decades
of operation.
 The Revised National Tuberculosis Control
Programme (RNTCP) is designed to address the
limitations of the earlier NTP i.e., lack of coverage
coverage, shortages of essential drugs, poor cure and
completion rates, poor quality of sputum microscopy,
and a series of factors that have resulted in a non-
friendly atmosphere for the patients.

4.  RNTCP is essentially a patient focused programme
and presently covers 600 million populations in the
country.
 The study covered 1444 beneficiaries, 180 opinion
leaders and 211 health service providers. As per the
methodology 50:50 ratio among male female
beneficiaries and HSPs were attempted.
 About 23% of the beneficiaries across the states were
illiterate but the opinion leaders were

5.  Basic TB facts
Tuberculosis
 Tuberculosis, MTB, or TB (short for tubercle bacillus)
is a common, and in many cases lethal, infectious
disease caused by various strains of mycobacteria,
usually Mycobacterium tuberculosis.
 Tuberculosis typically attacks the lungs
 TB infection cough, sneeze, or otherwise transmit
respiratory fluids through the air.

6.  An introduction to TB diseases
 TB is an infectious, usually curable disease that is
estimated to have killed 1.42 million people in 2011.
 There were an estimated 990,000 deaths from TB disease
in HIV negative people.
 In addition an estimated 8.7 million people developed
active TB disease.
 A third of the world’s population, nearly two billion
people, are estimated to have latent TB infection.
 Active TB or TB disease occurs when the TB bacteria
have started to multiply and they become numerous
enough to overcome the body’s immune system or
defences.

7.  How is TB spread?
 TB is spread through the air from one person to another.
 When a person with active TB disease of the lungs or
throat coughs, sneezes, or talks, droplets containing the
TB bacteria are released into the air, and they can then
cause TB infection if they are inhaled by someone else.

8.  Symptoms TB disease
 They may have pain in their chest and they may cough up
blood or phlegm from deep inside their lungs.
 Weakness or fatigue.
 Weight loss.
 Lack of appetite.
 Chills, fever and night sweats.

9.  Diagnosisng TB disease
Some of the diagnostic tools look directly for the bacteria
Chest X-ray Test
 Acute pulmonary TB can be easily seen on an X-ray.
 the picture it presents is not specific and a normal chest
X-ray cannot exclude extra pulmonary TB.
 The TB skin test
The TB skin test is a widely used diagnostic tool.
 The TB skin test involves injecting a small amount of
fluid (called tuberculin) into the skin in the lower part
of the arm. If the skin reacts by swelling after 48 to 72
hours, the person is probably infected with
Tuberculosis bacteria.
 The Mantoux test is the type of test most often used.

10.  Serological tests for TB
 Serological tests for TB are tests carried out on samples
of blood, and they claim to be able to diagnose TB by
detecting antibodies in the blood.
 TB drug susceptibility tests
 Drug susceptibility testing means testing to find out
which drugs the TB bacteria in a patient are susceptible
to, and can therefore determine whether the person has
got drug resistant TB.

11.  TB Drugs & Treatment
There are more than twenty drugs that are used for the treatment of TB
and all of them were developed some years ago.
1ST line TB drug(primery drug) 2nd line TB drug (reserve drug)
 Isoniazid
 Rifampicin
 Pyrazinamide
 Ethambutol
 and Streptomycin
 Para amino salicylic
acid(PAS)
 Ethionamide
 Cycloserine
 Thioacetazone
 Capreomycin
 Kanamycin
 Amikacin and
 Rifabutin

12. Category Type of patient Duration Regimen
Cat-1 a) New sputum +ve
b) Seriously ill sputum-
ve pulmonary TB
c) Seriously ill
extrapulmonary TB
Intensive phase
(2 month)
Continuation phase
(4 month)
INH+ETB+RMP
+PZA
INH+RMP
Cat-2 Retreatment group
a) Relapse
b) Treatment failure
patients
Intensive phase
(3 month)
Continuation phase
(5 month)
2 Month:INH+RMP
+ETB+SM+PZA
1 Month:INH+RMP
+ETB+PZA
INH+RMP+ETB
Cat-3 a) New smear –ve
(not seriously
ill)pulmonary
b) Extra pulmonary
Intensive phase
(2 month)
Continuation phase
(4 month)
INH+RMP+PZA
RMP+INH
WHO CATEGORISATION OF PATIENTS AND RECOMMENDED REGIMENS

13. DRUG DOSAGE CHART FOR ADULTS : WHO GUIDELINES
Drugs
FIR
INH
PZA
ETB
SM
Dose in
mg/kg
daily
10mg
(8-12)
5mg
(4-6)
25mg
(20-30)
15mg
(15-20)
15mg
(12-18)
Daily doses in mg
Under Under Over
33kg 50kg 50kg
300 450 600
200 300 300
750 1250 1500
600 800 1200
500 750 1000
Adverse effects
Hepatitis
Peripheral neuritis,Hepatitis
Arthritis
Optic neuritis
Renal

14.  RNTCP(REVISED THE NATIONAL TB CONTROL PROGRAMME)
 The Indian government's Revised National TB Control
Programme (RNTCP) was started in 1997 and was then
expanded across India until the entire nation was covered
by March 2006.
 The program uses the WHO recommended Directly
Observed Treatment Short Course (DOTS) strategy and
reaches over a billion people in 632 districts/reporting units

15.  Objectives of RNTCP
 To achieve and maintain a TB treatment success rate of
at least 85% among new sputum positive (NSP) patients.
 To achieve and maintain detection of at least 70% of the
estimated new sputum positive people in the community.
 In 2010 the RNTCP achieved a treatment success rate
of 87% of NSP patients and a detection rate of 71% of
the estimated NSP people in the community.

16.  Revised RNTCP targets(2012-17)
The aim is to achieve the following targets by the end of 2015:
 Early detection and treatment of at least 90% of estimated TB
cases in the community, including HIV associated TB.
 Initial screening of all previously treated (retreatment) smear-
positive TB patients for drug resistant TB and the provision of
treatment services for multi drug resistant TB.
 The offer of HIV counselling and testing for all TB patients,
and linking HIV infected TB patients to HIV care and support.
 Successful treatment of at least 90% of all new TB patients,
and at least 85% of all previously treated TB patients.
 The extension of RNTCP services to patients diagnosed and
treated in the private sector.

17.  Activities to achieve these targets
The RNTCP plans to achieve these targets by:
 using rapid diagnostics for the diagnosis of TB and drug
resistant TB
 expanding services for the management of multi drug
resistant TB
 strengthening urban TB control
 strengthening public-private mix initiatives
 improving the quality of basic DOTS services
 aligning with National Rural Health Mission supervisory
structures

18.  present cinnerio
 Incidence : 1.9 million new TB cases annually,
incidence more in north and in urban areas.
 Prevalence: 3.8 million bacteriologic ally
positive(2002).
 Deaths: about 325,000 deaths due to TB each
year.
 2.6 million people living with HIV ; 1.2 million
co-infected with HIV and TB.
 5% of TB patients estimated to be HIV positive.
 MDR-TB in new TB cases is ~3% and in
previously treated cases is~12%.
 About 20% of the world’s population is suffering
from TB and about 8 million people are
victimized each year.

19.  DOTS(Directly Observed Treatment Short course strategy)
 WHO in the mid 1990s further developed their “DOTS”, or
Directly Observed Treatment Short course strategy.
 This was to become the internationally recommended
approach to TB control until 2006.
DOTS has five components, which were initially as follows.
 Sustained political and financial commitment.
 Diagnosis by quality ensured sputum smear microscopy.
 Standardized short course anti TB treatment (SCC) given under
direct and supportive observation (DOT).
 A regular uninterrupted supply of high quality anti TB drugs.
 Standardized recording and reporting.

20.  Challenges
 Achieving universal access while maintaining and
furtherimproving the quality of services across the country.
 Continued motivation of human resources to perform
optimallyand maintaining the efficiency levels.
 Promoting rational use of first line and second line anti-
TBdrugs outside the programme for prevention of MDR and
XDRTB.
 Scaling up culture & DST and treatment services for MDR-
TB.
 Scaling up of PPM activities to link all providers to the
nationalprogramme
 TB-HIV collaboration.
 Promote operational research to address the local
challenges.
 Introduc tion of new tools for diagnosis and drugs for
treatment.

21.  Future plan
 Maintaining/ improving quality and reach of DOTS.
 Scaling up of MDR- TB management.
 Engaging all care providers.

22. REFERENCES:
 "Global Tuberculosis Control 2011", WHO, Geneva,
2011, 20
 "Global Tuberculosis Control 2011", WHO, Geneva,
2011, 38
 Hoffner, S. "Unexpected high levels of multidrug-
resistant tuberculosis present new challenges for
tuberculosis control", The Lancet, 30 August 2012 ,198-
202.
 “JoAnne L Flynn and John Chany (august 2003).
"Immune evasion by Mycobacterium tuberculosis: living
with the enemy". Current Opinion in Immunology 15 (4):
450.