India accounts for over one-fifth of the global tuberculosis burden with 2.2 million cases annually, the highest of any country. The Revised National Tuberculosis Control Programme (RNTCP) was established to address this large burden. The key components of RNTCP are based on the WHO-recommended DOTS strategy of using short course chemotherapy regimens administered under direct observation to ensure treatment adherence. Diagnosis involves microscopic examination of sputum samples and treatment regimens differ based on whether a patient is newly diagnosed or was previously treated. Regular follow-up during and after treatment is important to monitor symptoms, treatment response, and detect any recurrence of active TB.
Hello Guys,
This presentation consists of the updated guidelines under National tuberculosis elimination programme of India (MOHFW). The presentation includes case definitions and diagnostic algorithms for Pulmonary, Extrapulmonary and Drug resistant TB(MDR/ XDR TB) and the tratment protocols in pediatric cases.
Hope you find it useful.
National Leprosy Eradication Programme (NLEP) as on 08/12/2018Tapeshwar Kumar
Health Policy by Government of India under Ministry of Health & Family Welfare(Ministry of Health).
Better. Clarity on Google Drive Link:
https://drive.google.com/drive/folders/1L59zjagV1U4rzkEWe4eV7fW09Y6ZDA_M?usp=sharing
https://goo.gl/jAtCfv
You can remove footnote (TapeshwarAIIMS_3210/2015) by choosing the Header & Footnote option & deselecting it.
Immunization for INDIAN Adolescents Dr. Jyoti Agarwal Dr. Sharda Jain Dr. J...Lifecare Centre
Vaccinations are among the greatest public health achievements of the 20th century
First recorded in 1890-95
Imminization is the action of making a person immune to infection, typically by inoculation
Immunization prevents disability & death from infectious diseases
It also helps control the spread of infections within communities
Scrub typhus, also known as bush typhus, is a disease caused by a bacteria called ORIENTIA TSUTSUGAMUSHI.
Scrub typhus is spread to people through bites of infected chiggers (larval mites).
Most cases of scrub typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia. Anyone living in or travelling to areas where scrub typhus is found could get infected
Scrub typhus is not transmitted directly from person to person; it is only transmitted by the bites of vectors
Chiggers are abundant in locales with high relative humidity (60%–85%), low temperature (20°C–30°C), low incidence of sunlight, and a dense substrate-vegetative canopy.
Occupational risk is higher in farmers (aged 50–69 years), females.
National programme for prevention and control of cancer npcdcsanjalatchi
A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, most heart diseases, most cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others.
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
Hello Guys,
This presentation consists of the updated guidelines under National tuberculosis elimination programme of India (MOHFW). The presentation includes case definitions and diagnostic algorithms for Pulmonary, Extrapulmonary and Drug resistant TB(MDR/ XDR TB) and the tratment protocols in pediatric cases.
Hope you find it useful.
National Leprosy Eradication Programme (NLEP) as on 08/12/2018Tapeshwar Kumar
Health Policy by Government of India under Ministry of Health & Family Welfare(Ministry of Health).
Better. Clarity on Google Drive Link:
https://drive.google.com/drive/folders/1L59zjagV1U4rzkEWe4eV7fW09Y6ZDA_M?usp=sharing
https://goo.gl/jAtCfv
You can remove footnote (TapeshwarAIIMS_3210/2015) by choosing the Header & Footnote option & deselecting it.
Immunization for INDIAN Adolescents Dr. Jyoti Agarwal Dr. Sharda Jain Dr. J...Lifecare Centre
Vaccinations are among the greatest public health achievements of the 20th century
First recorded in 1890-95
Imminization is the action of making a person immune to infection, typically by inoculation
Immunization prevents disability & death from infectious diseases
It also helps control the spread of infections within communities
Scrub typhus, also known as bush typhus, is a disease caused by a bacteria called ORIENTIA TSUTSUGAMUSHI.
Scrub typhus is spread to people through bites of infected chiggers (larval mites).
Most cases of scrub typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia. Anyone living in or travelling to areas where scrub typhus is found could get infected
Scrub typhus is not transmitted directly from person to person; it is only transmitted by the bites of vectors
Chiggers are abundant in locales with high relative humidity (60%–85%), low temperature (20°C–30°C), low incidence of sunlight, and a dense substrate-vegetative canopy.
Occupational risk is higher in farmers (aged 50–69 years), females.
National programme for prevention and control of cancer npcdcsanjalatchi
A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, most heart diseases, most cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others.
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, 6-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.
In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 117 countries worldwide.
Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (such as Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.
New WHO recommendations aim to speed up detection and improve treatment outcomes for MDR-TB through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen. At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.
Solutions to control drug-resistant TB are to:
cure the TB patient the first time around
provide access to diagnosis
ensure adequate infection control in facilities where patients are treated
ensure the appropriate use of recommended second-line drugs.
In 2015, an estimated 480 000 people worldwide developed MDR-TB, and an additional 100 000 people with rifampicin-resistant TB were also newly eligible for MDR-TB treatment. India, China, and the Russian Federation accounted for 45% of the 580 000 cases. It is estimated that about 9.5% of these cases were XDR-TB.
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Pulmonary tuberculosis
The bacterium Mycobacterium tuberculosis causes tuberculosis (TB), a contagious, airborne infection that destroys body tissue. Pulmonary TB occurs when M. tuberculosis primarily attacks the lungs. However, it can spread from there to other organs.
New treatment regimen is mentioned here.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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2. India is the highest tuberculosis burden country accounting for
more than one-fifth of the global incidence
2
Indonesia
6%
Nigeria
5%
Other countries
20%
Other 13 HBCs
16% China
14%
South Africa
5%
Bangladesh
4%
Ethiopia
3%
Pakistan
3%
Phillipines
3%
India
21%
Source: WHO Geneva; WHO Report 2014: G Tuberculosis Control; Surveillance, Planning and Financing
Global annual incidence = 9.6 million
India annual incidence = 2.2 million
India is 17th
among 22
High Burden
Countries (in terms of
TB incidence rate)
7. END TB STRATEGY
VISION - A world free of TB – Zero Deaths , Disease and Suffering due to
TB
GOAL - END THE GLOBAL TB EPIDEMIC
INDICATORS
Reduction of TB Death
Compared with
2015(%)
Reduction in TB
Incidence Rate
Compared to 2015(%)
TB Affected Family
facing Catastrophic
cost due to TB(%)
MILESTONES TARGETS
2020 2035 SDG 2020 END TB
2035
35% 75% 90% 95%
20%
(<85/100,000
)
50%
(<55/100,000
)
80%
(<20/100,000
)
90%
(<10/100,000
)
0 0 0 0
8. The Components Of The New
End TB Strategy
Pursue High quality DOTS expansion and enhancement
Address Tuberculosis/HIV, MDR-TB and other challenges
Contribute to health system strengthening
Engage all health care providers
Empower people with Tuberculosis, and communities
Enable and promote research
8
9. Unique Features of RNTCP
District Tuberculosis Control Society
• Modular training
• Patient wise boxes
• Sub-district level supervisory staff (STS, STLS) for
treatment & microscopy
• Robust reporting and recording system
9
13. •Presumptive DR TB-
Refers to those patient who have failed treatment
with first line drugs, patients who are contacts of DR-
TB ,TB patients who are found positive on any
follow-up sputum smear examination during
treatment with first line drugs, previously treated TB
cases, TB patients with HIV co-infection.
14. •Microbiologically confirmed TB Case-
Refers to a presumptive TB Patient with
biological specimen positive for acid fast
bacilli, or positive for Mycobacteriuom
tuberculosis on culture, or positive for
tuberculosis through quality assured rapid
diagnostic molecular test.
Case definitions
15. •Clinically diagnosed TB Case-
Refers to a presumptive TB Patient who is
not microbiologically confirmed, but has
been diagnosed by the clinician on the
basis of X-ray abnormalities,
histopathology or clinical signs with a
decision to treat the patient with a full
course of Anti-TB treatment.
16. • Pulmonary tuberculosis (PTB)-
Refers to any microbiologically confirmed or
clinically diagnosed case of TB involving the lung
parenchyma or the tracheo-bronchial tree.
• Extra Pulmonary tuberculosis(EPTB)-
Refers to any microbiologically confirmed or
clinically diagnosed case of TB involving organs
other than the lungs such as pleura, lymph node,
intestine, genitourinary tract, joints and bones,
meninges of the brain etc.
Miliary TB is classified as pulmonary TB because
there are lesions in the lungs.
A patient with both PTB and EPTB should be
classified as a case of PTB.
17. New case – A TB patient who has never had treatment for TB
or has taken ATD for <1 month.
Previously treated patients have received one month or
more ATD in the past. This may be:
•Recurrent TB case – A TB patient previously declared as
successfully treated (cured/treatment completed) and who
is subsequently found to be microbiologically confirmed TB
case is a recurrent TB case. (Previously called relapse.)
•Treatment after failure – Patients are those who have
previously been treated for TB and whose treatment failed
at the end of their most recent course of treatment.
18. •Treatment after loss to follow-up – A TB
patient previously treated for TB for one month
or more and who was declared lost to follow-
up in their most recent course of treatment and
subsequently found microbiologically
confirmed TB cases.
•Other previously Treated Patients- Are
those who have previously been treated for TB
but whose outcome after their most recent
course of treatment is unknown or
undocumented.
19. Transferred in:
A TB Patient who is received for treatment in a Tuberculosis
Unit, after registered for treatment in another TB Unit .
Mono resistance (MR) – A TB patient whose biological
specimen is resistant to one first-line anti-TB drug only.
Poly resistance (PDR) – A TB patient whose biological
specimen is resistant to more than one first-line anti-TB drug,
other than both INH and Rifampicin.
Multi-drug resistance (MDR) – A TB patient whose biological
specimen is resistant to both INH and Rifampicin with or
without resistance other first-line ATD, based on results from a
Quality Assured Laboratory. (No changes.)
20. Rifampicin resistance (RR) – Resistance to
Rifampicin detected by phenotypic or genotypic
methods with or without resistant to other ATD
excluding INH. Patient with RR should be managed as
if they are in MDR TB case.
Extensive drug resistance (XDR) – MDR TB case
whose biological specimen was resistant to a
Fluroquinolone (FQ) and a second-line injectable ATD
from a Quality Assured Laboratory. (No changes.)
21. Treatment outcomes
Cured
A microbiologically confirmed TB at the beginning of the
treatment who was smear- or culture-negative at the end of
complete treatment
Treatment completed
Treatment completed as recommended by the national
policy without evidence of failure BUT no record that three or
more consecutive cultures taken at least 30 days apart are
negative after the intensive phase
Treatment success
TB patients either cured or treatment completed are
accounted in the treatment success. (New addition).
22. Lost to follow-up
A TB patient whose treatment was interrupted for one
consecutive month or more. (New addition).
Not evaluated
A TB patient for whom no treatment outcome is assigned.
(Former transfer out).
Treatment regimen changed
Previously, it was called as switched over to MDR treatment.
A patient who has been diagnosed as having MDR-TB by an
RNTCP accredited laboratory, prior to being declared as
Failure, and is placed on the RNTCP MBR-TB treatment
regimen.
23. Died
Patient who died during the corse of treatment regardless of
any cause.
Failure
A TB patient whose biological specimen is positive by smear
or culture at the end of the treatment. (Changed).
24. Tools for microbiological
confirmation of TB
Sputum Smear Microscopy (for AFB): Zeihl-
Neelson Staining and Fluorescence staining.
Culture: Solid (Lowenstein Jensen) media or
Agar-based 7H11/10 medium
Automated Liquid culture systems.
Drug Sensitivity Testing:
Modified DST for MGIT (Mycobacteria growth
indicator tube system) 960 system (for both first
and second line drugs).
25. Rapid molecular diagnostic testing:
Line Probe Assay for MTB complex and detection of RIF& INH
resistance
Nucleic Acid Amplification Test (NAAT) Xpert MTB/Rif testing using
the GeneXpert system. Used in sputum and as well as extra-
pulmonary specimen. Dx of DR-TB.
Radiology, TST(tuberculin skin test) ,IGRA (interferon gamma release
assay) are other tools for diagnosis of tuberculosis.
26. Two samples are collected within a day or two consecutive days.
One sample is collected on the spot under supervision and other is
collected early in the morning.
Sputum should be at least 2 ml in quantity.
Results of sputum tests should be reported within a day.
29. Sputum Specimen
specimen
“a” (first
specimen)
The spot sputum specimen, irrespective of
whether it is collected prior or after the
morning specimen
specimen “b”
second
specimen
The morning specimen
“c” specimen The space for the “c” specimen should be left
blank.
29
30. Sputum Smear Interpretation
30
If The Slide Has
(NO. Of AFB)
Result Grading No. Of Fields
To Be
Examined
No AFB In 100 Oil Immersion Fields Neg 0 100
1-9/100 Oil Immersion Fields Pos Scanty* 100
10-99/100 Oil Immersion Fields Pos 1+ 100
1-10/Oil Immersion Field Pos 2+ 50
>10/Oil Immersion Field Pos 3+ 20
*Record Actual Number Of Bacilli Seen In 100 Fields – eg. “Scanty 4”
Smear-positive results including those of scanty positives are always recorded
in Red ink in the tuberculosis laboratory register
31. The most common symptom of pulmonary Tuberculosis is a
persistent cough for two weeks or more
Patients suspected to have pulmonary Tuberculosis should have two
sputum smears examined
Sputum samples should be examined as soon as possible and not
later than 2 DAYS after it is collected
31
32. The strategies adopted in the treatment of TB are based
on both scientific and operational research.
1. Domiciliary treatment
2. Short course chemotherapy
3. Intermittent regimen
4. Direct observation of treatment
Domiciliary Treatment
Domiciliary chemotherapy has been proved to be as effective
as sanatoria treatment. Smear-positive TB patients treated
on a domiciliary basis have achieved high cure rates as good
as those when treated at sanatorium, besides having
other social benefits of being at home.
33. Short Course Chemotherapy
Short course chemotherapy regimens have made it possible to
treat and cure TB patients in as short a period as six to eight
months. Reduction in the duration of treatment regimens was
possible because of the introduction of Rifampicin and
Pyrazinamide. Thus contributed to improvement in the treatment
adherence.
34. Isoniazid (H): Isoniazid is a potent drug, exerting early
bactericidal activity, prevents emergence of drug resistant
mutants to any companion drug and has low rates of adverse
drug reactions.
Rifampicin (R): Rifampicin is a potent bactericidal and
sterilizing drug acting on semidormant bacilli which multiply
intermittently, thereby causing relapse.
Pyrazinamide (Z): Pyrazinamide is a bactericidal and
sterilizing drug effective in eliminating the semi-dormant
bacilli multiplying slowly in an acidic environment.
Ethambutol (E): Ethambutol is an effective bacteriostatic
drug helpful in preventing emergence of resistance to other
companion drugs.
Streptomycin (S): Streptomycin is a bactericidal drug known
to reduce septicaemia and toxicity
35. Intermittent Treatment
Intermittent regimens should only be used in a programme
of directly observed treatment (DOT). The formulation of
intermittent regimens in the treatment of TB is based on the
principle of existence of lag period. “In vitro experiments
demonstrated that, after a culture of M. tuberculosis is
exposed to certain drugs for some time, it takes several
days before new growth occurs”. Thus, there is no need to
maintain blood levels of drugs for 24 hours in the treatment
of tuberculosis
Advantages of intermittent regimen are:
1. As effective as daily treatment
2. Facilitates DOT
3. Reduction in total quantity of drugs consumed
4. Fewer adverse reactions
36. Directly Observed Treatment Short-course Chemotherapy
(DOTS)
DOT is a supportive mechanism that ensures the best
possible results in treatment of TB. Here, a DOT Provider
helps the patient in taking the treatment, thereby ensuring
adherence.
Studies shown that there will be poor treatment outcome and
high death rates in the absence of DOT, even when regular
supply of drugs is ensured. Hence, by providing DOT, RNTCP
ensures that patients receive the right drugs, in the right
doses, at the right intervals and for the right duration.
37. The five key components of DOTS
1. Political commitment to control Tuberculosis
2. Case detection by sputum smear microscopy
examination among symptomatic patients
3. Patients are given anti-Tuberculosis drugs
under the direct observation of the health care
provider/community DOT provider.
4. Regular, uninterrupted supply of anti-
Tubeculosis drugs
5. Systematic recording and reporting system that
allows assessment of treatment results of each
and every patient and of whole Tuberculosis
control programme
37
38.
39. Treatment
Groups
Type of
patient
Regimen
Intensive Phase
(IP)
Continuation
Phase (CP)
New
•New includes
former categories I
and III
•Red coloured Box
•TOTAL -78 dose
•Sputum smear-
positive
•Sputum smear-
negative
•Extra-pulmonary
•Others
2H3R3Z3E3 4H3R3
Previously
Treated
•Smear-positive
relapse
•Smear-positive
failure
•Smear-positive
treatment after
default
•Others
2H3R3Z3E3S3
/ 1H3R3Z3E3
5H3R3E3
39
“NEW”
•Red coloured
Box
•78 dose
•Includes former
categories I & III
•TOTAL -78 dose
41. Dosages For Anti-tuberculosis
Drugs In mg/Kg Body Wt
Drug Daily Dosage, mg/kg
(range)
Daily
Treatment
Treatment
three times a
week
Isoniazid H 5 (4-6) 10 (8-12)
Rifampicin R 10 (8-12) 10 (8-12)
Streptomycin S 15 (12-18) 15 (12-18)
Ethambutol E 15 (13-17) 30 (25-35)
Pyrazinamide Z 25 (20-30) 35 (30-40)
48. Follow-up of treatment:
Clinical follow-up – (new addition)
Should be at least monthly – the patient may visit the clinical
facility, or the medical officer may conduct the review when
she/he visits the house of the patient to observe improvement
of chest symptoms, weight gain, control the co-morbid
conditions such as HIV and diabetes and to monitor any
adverse reaction to ATD.
Follow-up laboratory investigation
For PTB cases – sputum smear examination at the end of IP
and at the end of treatment. (In the previous guidelines,
follow-up sputum smear to be done at 2, 4 and 6 months for
new cases and 3, 5 and 8 months in previously treated
cases.)
49. •In case of clinical deterioration, the Medical Office may
consider repeat sputum smear even during CP. (New
addition.)
•At the completion of treatment, sputum smear and culture
should be done for every patient
•CXR – to be offered whenever required and available.
Long-term follow-up
After completion of treatment, the patient should be followed
up at the end of 6, 12, 18 and 24 months. Any clinical
symptoms and/or cough, sputum microscopy and/or culture
should be considered.