Dots

Lecture By Dr.sati Moh'd Saleh
Fever Consultant

1. Dr. Satti M. Saleh Chief of Infectious Diseases Department MGH Director of IC Unit Meeqat General hospital CBAHI IC TEAM Member Medical Director Meeqat General Hospital W HO DOTs Strategy To Stop TB

2. History * Mycobacterium tuberculosis * MoTT * 24/3/1882 (Robert Koch) * 1993 (WHO – International Emergency) * 2000 ( Global partenership (STOP TB)) * DOT strategy * DOTS strategy * 2006 ( THE STOP TB STRATEGY )

3. CLINICAL SYNDROMS Primary TB ( 1 st Exposure) * Laten TB * Reactivation TB * Pulmonary TB * Extra pulmonary TB

4. DIAGNOSIS : AFB stain * Culture LJmedia Bactec * Molecular Method PCR Species determination Drug resistant mutation Typing * Others

5. BASIC CONTROL Detection of cases * Treatment (DOT) * INH Prophylaxis for high risk * Contact investigation * Isolation

6. Standardized short-course anti-TB treatment (SCC) given under direct and supportive observation (DOT).  1- INH 5mg /kg 2- RMP 10mg/kg 3- PZA 20-25mg/kg 4- ETM 15-25mg/kg 4 Drugs for 1 st 2 months 1st 2 Drugs for 2 nd 4 months

7. Isolation AIRBORNE Negative pressure HEPA filters HEPA mask Special mask for patient Pulmonary TB S+A Till sputum Negative

8. DRUG RESISTANT TB Mono resistant ( 1 drug) * Poly Resistant ( ~ 1 not MDR) * MDR (INH + RIF) * Extensively resistant (XDR – all 1 st line)

9. Other drugs 1- Amikacine 2- Kanamycine 3- Thiacetazone 4-Quinilone 5- cycloserine 6-clofazemine

10. TREATMENT O F LATENT INFECTION * Tuberculin test * PPD + ve * PPD - ve (2 step testing) * ( Avoid misclassification )

11. INDICATION HIV ≥ 5mm * Immunosuppressive drugs ≥ 5mm * Close contact of TB patient ≥ 5mm Fibrotic lesion on CXR ≥ 5mm 2years ~10mm > Recently infected person * High risk medical conditions ~10mm * Low risk ~ 15mm

12. DOTS STRATEGY - Detect smear + ve case & reporting - Observation of therapy( DOTs ) - Treatment monitoring ( recording, reporting assessment ) - - Short course (Drug Supply) - Government & non – government commitment

13. STOP TB STRATEGY (2006 – 2015 ) * DOTs * TB + HIV * Health System support * Engage all health care provider * Empower people with TB & community *Enable & promote research

14. Standardized recording and reporting Helps to keep track of each individual patient and to monitor overall programme performance

15. Sustained political and financial commitment. TB can be cured and the epidemic reversed if adequate resources and administrative support for TB control are provided