4.Dots

1. TREATMENT OF TUBERCULOSIS
TREATMENT OF
TUBERCULOSIS
REVATHY.V
ROLL NO. 62

2. OBJECTIVES OF TREATMENT
3.TO DECREASE MORTALITY AND LONG TERM MORBIDITY BY ENSURING
PERMANENT CURE
2. TO DECREASE TRANSMISSION OF INFECTION
3. TO ACHIEVE THE ABOVE WHILE MINIMISING SIDE EFFECTS DUE TO
DRUGS.
D
O
T
S

3. ANTI- TB DRUGS
FIRST LINE SECOND LINE
ISONIAZID THIOACETAZONE
RIFAMPICIN PAS
PYRAZINAMIDE ETHIONAMIDE
ETHAMBUTOL CYCLOSERINE
STREPTOMYCIN KANAMYCIN
CAPREOMYCIN
AMIKACIN
NEWER DRUGS
CIPROFLOXACIN
OFLOXACIN
CLARITHROMYCIN
AZITHROMYCIN
RIFABUTIN

5. CONVENTIONAL CHEMOTHERAPY
ISONIAZID ALONG WITH ONE OR MORE BACTERIOSTATIC DRUGS
DURATION: 18 MONTHS
REGIMENS:
DAILY REGIMENS
INTERMITTENT REGIMENS

6. SHORT COURSE
CHEMOTHERAPY(SCC)
DURATION
6-9 MONTHS
ADVANTAGES
RAPID BACTERIOLOGICAL CONVERSION
LOWER FAILURE RATES
REDUCTION IN EMERGENCE OF DRUG RESISTANT BACILLI
TWO PHASES
INTENSIVE PHASE
1-3 MONTHS
TO KILL OFF AS MANY FAST MULTIPLYING BACILLI AS POSSIBLE
CONTINUATION PHASE
4-6 MONTHS
TO KILL THE REMAINING DORMANT BACILLI

7. CHEMOTHERAPY
AND DOTS
REVATHY.V
ROLL NO. 62
THENDRAL’06

8. DIRECTLY OBSERVED
TREATMENT
SHORTCOURSE(DOTS)
INTENSIVE
PHASE
UNDER DIRECT
SUPERVISION OF A
HEALTH WORKER OR
TRAINED PERSON
CONTINUATI
ON PHASE
A MULTIBLISTER
COMBIPACK WITH
DRUGS FOR 1
WEEK IS GIVEN OF
WHICH THE FIRST
DOSE IS TAKEN
UNDER
SUPERVISION
•PATIENT WISE BOXES
•THRICE WEEKLY REGIMEN-MORE EFFECTIVE

9. TUBERCULOSIS CASE DEFINITIONS
PULMONARY TUBERCULOSIS, SMEAR POSITIVE
PULMONARY TUBERCULOSIS, SMEAR NEGATIVE
EXTRA PULMONARY TUBERCULOSIS
TYPE OF PATIENTS
NEW
RELAPSE
TRANSFERRED IN
TREATMENT AFTER DEFAULT
FAILURE
CHRONIC
OTHERS

10. TREATMENT OUTCOME
CURED
TREATMENT COMPLETED
DIED
FAILURE
DEFAULTED
TRANSFERRED OUT

11. TREATMENT REGIMEN
CATEGORY I
(RED BOX)
INDICATIONS
NEW SPUTUM SMEAR POSITIVE
SERIOUSLY ILL SPUTUM SMEAR- NEGATIVE
SERIOUSLY ILL EXTRA- PULMONARY
REGIMEN
2(HRZE)
3
4(HR)3
PREPARATION: PATIENT WISE BOXES
IP POUCH : 24 SINGLE DAY STRIPS
CP POUCH : 18 WEEKLY BLISTERS

12. EXTRA-PULMONARY TB - SERIOUSLY ILL
 MENINGITIS
PERICARDITIS
PERITONITIS
BILATERAL OR EXTENSIVE PLEURAL EFFUSION
SPINAL TB WITH NEUROLOGICAL INVOLVEMENT
INTESTINAL
GENITO-URINARY
CO-INFECTION WITH HIV
ALL FORMS OF PEDIATRIC EXTRA PULM TB OTHER THAN LYMPH
NODE TB AND UNILATERAL PLEURAL EFFUSION
SMEAR NEG PULM TB- SERIOUSLY ILL
MILIARY
EXTENSIVE PARENCHYMAL INFILTRATION
CO-INFECTION WITH HIV
CAVITARY DISEASE
ALL FORMS OF SPUTUM SKEAR NEG PULM TB EXCEPT PRIMARY
COMPLEX

13. CATEGORY II
(BLUE BOX)
INDICATIONS
SPUTUM SMEAR- POSITIVE
RELAPSE
FAILURE
TREATMENT AFTER DEFAULT
REGIMEN:
2(HRZES)3
1(HRZE)3
5(HRE)3
:
PREPARATION
PATIENT WISE BOXES
IP POUCH : 36 SINGLE DAY STRIPS WITH 24 SM VIALS
CP POUCH : 22 WEEKLY BLISTERS

14. CATEGORY III
(GREEN BOX)
INDICATIONS
NEW SPUTUM SMEAR NEGATIVE, NOT SERIOUSLY ILL
NEW EXTRA-PULMONARY, NOT SERIOUSLY ILL
REGIMEN:
2(HRZ)3
4(HR)3
:
PREPARATION
IP POUCH : 24 SINGLE DAY STRIPS
CP POUCH : 18 WEEKLY BLISTERS

15. DRUG DOSE
ISONIAZID 600 mg
RIFAMPICIN 450 mg*
PYRAZINAMIDE 1500 mg
ETHAMBUTOL 1200 mg
STREPTOMYCIN 750 mg**
DOSAGE
*PATIENTS WHO WEIGH 60 KG OR MORE – EXTRA I50 MG OF
RIFAMPICIN GIVEN
**PATIENTS OVER 50 YEARS OF AGE ARE GIVEN 500MG OF
STREPTOMYCIN

16. PAEDIATRIC DOSAGE

17. MODE OF ADMINISTRATION:
IP : THRICE WEEKLY(MON, WED, FRI OR TUE, THU OR SAT)
EACH DOSE UNDER DIRECT OBSERVATION
CP : THRICE WEEKLY (MON, WED, FRI OR TUE, THURS OR SAT)
FIRST DOSE OF THE WEEK UNDER DIRECT OBSERVATION
FOLLOW UP SPUTUM EXAMINATION SCHEDULE
FIRST FOLLOW UP – AT THE END OF INTENSIVE PHASE IN ALL
CATEGORIES
SECOND FOLLOW UP – 2 MONTHS AFTER STARTING
CONTINUOUS PHASE
FINAL FOLLOW UP – AT THE END OF TREATMENT

18. FOLLOW UP SPUTUM EXAMINATION SCHEDULE
CAT I
0 2 4 6
+ NEG NEG NEG
0 2 3 5 7
+ + NEG NEG NEG
0 2 3 5 7
+ + + NEG NEG

19. REACTIONS
DRUG RESPONSIBLE
RENAL FAILURE,SHOCK,
THROMBOCYTOPENIA
RIFAMPICIN
HEPATITIS PYRAZINAMIDE
VISUAL DISTURBANCE ETHAMBUTOL
HEARING LOSS,
DISTURBED BALANCE
STREPTOMYCIN
SEVERE RASH,
AGRANULOCYTOSIS
THIOACETAZONE
ADVERSE REACTIONS

20. TREATMENT UNDER SPECIAL CLINICAL
SITUATIONS
HOSPITALIZATION
EXTREMELY ILL
TUBERCULOUS MENINGITIS
DURATION- 8 -9 MONTHS
STEROIDS GIVEN
PREGNANT WOMEN
STREPTOMYCIN IS CONTRAINDICATED
WOMEN ON OCPs
INCREASE THE DOSAGE OF OCP OR SWITCH OVER TO OTHER METHODS
HEPATOTOXICITY OR HEPATIC DISEASE
H, R, Z SHOULD BE AVOIDED

21. HIV-TB
SERIOUSLY ILL
HIV STATUS SHOULD NOT BE MENTIONED IN ANY
RECORDS
CAT I REGIMEN
SHOULD BE FIRST TREATED UNDER DOTS
IF CD4 COUNT IS VERY LOW, REPLACE NEVIRAPINE WITH
EFAVIRENZ

22. MDR-TB
ATLEAST RESISTANT TO INH AND RIFAMPICIN
TREATMENT BASED ON DOTS – PLUS
DOTS- PLUS(CAT IV)
INTENSIVE PHASE 6-9 MONTHS
KANAMYCIN
OFLOXACIN
CYCLOSERINE
ETHIONAMIDE
ETHAMBUTOL
PYRAZINAMIDE
CONTINUATION PHASE 18 MONTHS
OFLOXACIN
CYCLOSERINE
ETHIONAMIDE
ETHAMBUTOL

23. XDR-TB
RESISTANT TO
RIFAMPICIN AND INH(MDR-TB)
FLUROQUINOLONE
1 OR MORE OF SECOND LINE INJECTABLE DRUGS

24. ACTION FOR PATIENTS WHO INTERRUPT
TREATMENT
VISIT SHOULD BE MADE TO THE PATIENT’S HOME
WITHIN 24 HOURS IN INTENSIVE PHASE
WITHIN 7 DAYS IN CONTINUATION OHASE

26. A CHILD AGED 6 YEARS IS FOUND TO
BE TUBERCULIN POSITIVE. HE WAS
ALREADY VACCINATED FOR BCG.
THERE IS ALSO CONTACT OF
TUBERCULOSIS.
YOU WANT TO FIND IF THE POSITIVITY
IS DUE TO BCG VACCINATION OR
LATENT TB. HOW WILL YOU FIND?

27. INTERFERON GAMMA ASSAY