The document details the tuberculosis (TB) treatment regimens used in Nepal for the fiscal year 2074/2075, emphasizing both new and retreatment cases, including the phases of treatment and specific tests for drug resistance. It outlines the categorization of drugs, including the phasing out of certain regimens and the introduction of shorter and longer MDR-TB treatment regimens. Additionally, it highlights the use of novel drugs like bedaquiline for complex TB cases.

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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