Tuberculosis a common disease to come across in family practice is addressed with clarity on salient features that help Family Physicians to deal with Tb Treatment efficiently

1. 22/04/2018 Respiratory Diseases Management Course 2017-18
Respiratory Diseases
Management Course
2017-18
22/04/2018 Ahmedabad

2. 22/04/2018 Respiratory Diseases Management Course 2017-18
Treatment of Drug
Sensitive Tuberculosis
Dr. Amit Thaker M.B.B.S.
Senior Family Physician
AHMEDABAD

3. Goal of TB Treatment
• Decrease case fatality & morbidity by
ensuring relapse free cure
• Minimize & prevent development of drug
resistance
• Render patient non-infectious, break the
chain of transmission and decrease pool
of infection

4. Efficacy of regimen
Better treatment means
•Successful early outcome
– High sputum conversion
– High treatment success
•Long-term outcomes
– Low relapse
– Low emergence of drug resistance

5. Standards of TB Care in India..
Standard 7: Treatment with first-line regimen
7.1 Treatment of New TB patients:
•The initial phase - H, R, Z, E for two months
•The continuation phase - H, R, E for at least four months
7.2 Extension of Continuation Phase: Extend CP by 3 to 6 months in special situations like Bone
& Joint TB, Spinal TB with neurological involvement and neuro-tuberculosis.
7.3 Drug Dosages: As per body weight in weight bands
7.4 Bioavailability of Drugs: ensured for every batch
7.5 Dosage frequency:
•Daily/ Intermittent regimen
•OR to assess the feasibility of daily observed therapy under programmatic settings.
7.6 Drug formulations: FDCs may be considered if the recommendations are accepted.
7.7 Previously treated TB patients: No MDR :- 2HREZS/1HREZ/5HRE or
2H3R3E3Z3S3/1H3R3E3Z3/5H3R3E3

7. Inj. Streptomycin
• 15 mg/kg (12–18 mg/kg) daily
• Maximum daily dose 1000 mg
• Patients aged over 50 years may not be able to
tolerate more than 750 mg daily
• Similarly, patients weighing less than 50 kg may
not tolerate doses above 500-750 mg daily

8. Daily Dose Schedule for Adults
(as per weight bands)
Weight band Number of tablets Inj.
Streptomycin
Intensive phase Continuation
phase
HRZE HRE
75/150/400/275 mg 75/150/275 mg gm
25-39 kg 2 2 0.5 gm
40-54 kg 3 3 0.75 gm
55-69 kg 4 4 1 gm
≥70 5 5 1 gm

9. Key Product Information (Paediatric)
(Dispersible FDC)
• Rifampicin 75 mg + Isoniazid 50 mg + Pyrazinamide 150
mg
• Rifampicin 75 mg + Isoniazid 50 mg
(Formulation: Dispersible, flavored —Mango, Strawberry & Raspberry)
• Ethambutol 100 mg
• Isoniazid 100 mg
(Formulation: Dispersible)
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10. Drug Dosage for Paediatric TB
Weight
category
Number of tablets
(dispersible FDCs)
Inj.
Streptomyc
in
Intensive phase Continuation phase
HRZ E HR E
50/75/150 100 50/75 100 mg
4-7 kg 1 1 1 1 100
8-11 kg 2 2 2 2 150
12-15 kg 3 3 3 3 200
16-24 kg 4 4 4 4 300
25-29 kg 3 + 1A*
3 3+1A* 3 400
30-39 kg 2 + 2A*
2 2+2A* 2 500
*
A=Adult FDC (HRZE = 75/150/400/275; HRE = 75/150/275)

11. Follow up of Treatment
* If required

12. Long term follow up
• After completion of treatment, the patients
should be followed up at the end of 6, 12, 18 &
24 months.
• In presence of any clinical symptoms and/or
cough, sputum microscopy and/or culture should
be considered. This is important in detecting
recurrence of TB at the earliest.

13. 4FDC

14. 3FDC

15. Pyridoxine in TB Regimen
• Tab pyridoxine not required for all TB patients
• To prevent INH related neuropathy in persons at
high risk of Vitamin B6 deficiency
– Alcoholics
– Malnourished persons
– Pregnant and lactating women
– Patients with conditions such as chronic renal
failure, diabetes,
• While treating NTM
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16. Thank you

17. 22/04/2018 Respiratory Diseases Management Course 2017-18
Module Coordinator