TREATMENT REGIMEN

Patient wise boxes with multiblister combipack

Phases of Treatment

Intensive Phase

• Meant to kill as many bacilli rapidly as possible

Continuation Phase

• Aimed to sterilize smaller number of dormant/persisting bacilli to prevent relapse.

Category I(New)

•New smear positives•New sputum smear negative•New extra-pulmonary •New others

Red Box• IP= 2 (HRZE)3

•CP=4 (HR)3

Blue Box• IP=2 (HRZES)3+1(HRZE)3 • CP= 5 (HRE)3

Category II(Previously

treated)

•Smear positive relapse•Smear positive failure•Smear positive treatment after default•Others

Follow Up• Two sputum smears are examined each time during follow up.

1. As early morning sample2. Spot sample

Category SS –ve at the end of IP

SS +ve at the end of IP

I 2,4,6th month 2,3,5,7th month

II 3,5,8th month 3,4,6,9th month

At the end of IPBoth SS -ve

Patient put to CPSS exam repeated

CP continuedSS exam repeated

Either of them +veIP extended to 1 month

SS +ve / -vePatient put to CP

-ve SSCP continuedSS exam

repeated+ve SSTreatment failureCategory II

2n

d

month

3r

d

month

4t

h

month

5t

h

month

6t

h

month

7t

h

month

Category I :

At the end of IPBoth SS -vePt. put

to CP SS exam repeatedContd CP

SS exam repeated

Either of them +veIP extended to 1 monthSS +ve /

-vePt. put to CPSS exam repeatedSS exam

repeated

3r

d

month

4t

h

month

5t

h

month

6t

h

month

8t

h

month

9t

h

month

Category II :

Drug ResistancePrimary/ Pre-treatment resistance:

• The resistance shown by the bacteria in a patient, who has not received the drug in question before.

• Due to infection by drug resistant bacilli / during multiplication by transference of ‘episome’ from one resistant bacilli to another.

Secondary / Acquired resistance:

• The resistance shown by the bacteria which were sensitive to the drug at the start of the treatment but became resistant to the particular drug during the course of treatment.

Multi Drug Resistant (MDR) TuberculosisAccording to WHO, MDR strain is one that is at

least resistant to Rifampicin and Isoniazid, with or without resistance to other anti-TB drugs.

CATAGORY IV (DOTS-PLUS)Treatment of MDR-TB

Indication:1. History of prior treatment where smear

positive cases found even after repeated treatment courses, category II failure.

2. Close exposure to possible source cases, confirmed to have drug resistant TB.

Diagnosis must be confirmed by culture and Drug Sensitivity Testing (DST)

RNTCP Regimen

IP= 6(9) Km Ofx Eto Cs Z E + CP= 18 Ofx Eto Cs E

Extensively Drug Resistance Tuberculosis

• Extensively drug resistance (XDR) is defined as the strain which is resistant to:

1. at least Rifampicin and INH (i.e. MDR)2. A Fluoroquinolone, and3. one or two following second line injectable

drugs: Amikacin, Capreomycin, Kanamycin

Standardized regimen for XDR-TB:Intensive phase: • Capreomycin• PAS• Moxifloxacin• Linezolid • Clofazimine• Amoxicillin/ ClavulinateContinuation phase:• PAS• Moxifloxacin• Isoniazid• Clofazimine• Linezolid• Amoxicillin/ Clavulinate

6-12 months

18 monthsV

Category V

Teratogenic Drugs: Avoided

during Pregnancy

Alternative drugs, i.e. Ethambutol must be used instead of Streptomycin.

First line Second lineStreptomycin Ethionamide

Protionamide

Fluoroquinolones

Non DOTS Regimen

Indication: When there is adverse reaction to drugs used in short course chemotherapy. When patient cannot comply with the DOTS regimen.

• New smear positive• Pulmonary seriously ill patients• Extra pulmonary seriously ill

patients

Non-DOTS regime 1 (ND1):

2 (S H E) + 10 (H E)

• New smear negative• Pulmonary not seriously ill patients• Extra pulmonary not seriously ill

patients

Non-DOTS regime 2 (ND2):12 (H E)

• New smear negative• Pulmonary not seriously ill patients• Extra pulmonary not seriously ill

patients

Non-DOTS regime 2 (ND2):12 (H E)