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  • Drug-Sensitive Tuberculosis(DS-TB)

    Content

    What is Drug-Sensitive Tuberculosis (DS-TB)?

    • DSTB is a case where a person is infected with TB bacteria that are susceptible to all first line anti-TB drugs. It means that all of the first line TB drugs will be effective as long as they are taken properly and regularly.

    • This type of TB has the best prognosis and the shortest treatment duration.

    • Patients diagnosed with TB are considered to be DS-TB case, till such time s/he detected with resistance to any anti-TB drugs.

      

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  • DSTB Treatment Phases

    Content

    DSTB Treatment duration is of 6–9-month course of antibiotics. The duration and drug dosage used may vary according to a patient’s age, type of TB infection, and whether s/he has been treated before.

    The standard 6-month course of treatment consists of two phases. 

    Intensive Phase(IP)

    Continuation Phase(CP)
    • The first phase lasts 2 months.
    • 4 drug regimen(HRZE) is given as part of IP.
    • The second phase lasts 4 months
    • 3 drug regimen(HRE) is given as part of CP.

    *Extension of CP: Depending upon response to treatment or type of disease, physician may decide to extend the treatment by 3 months.

     

  • Treatment Regimen for DSTB – Adult

    Content

    Intensive Phase(IP): Consists of eight weeks (56 doses) of HRZE in daily dosages as per weight of patient.

    Continuation Phase(CP): Consists of 16 weeks (112 doses) of HRE in daily dosages as per weight of patient.

    For adults, there are five weight bands, as shown in the table below. The table also indicates the number of FDC tablets that have to be consumed in each weight band

    Weight band category

    Intensive phase(IP)

    (HRZE - 75/150/400/275)

    Continuation phase(CP)

    (HRE - 75/150/275)

    25–34 kgs

    2

    2

    35–49 kgs

    3

    3

    50–64 kgs

    4

    4

    65–75 kgs

    5

    5

    >=75 kgs

    6

    6

    Regular monthly follow up of the patient needs to be done and if patient loses or gains approx. 5 kg weight and if weight band changes during the treatment, then the dose of the patient needs to be recalculated.
     

  • Adverse Drug Reactions(ADRs) to First Line Treatment

    Content

    Symptoms

    Drug Responsible

    Action to be taken by Community Health Volunteers

    Gastrointestinal Symptoms 

    Any Oral Medications

    • Reassure patient. 

    • Give TB Drugs with less water at a longer interval. 

    • If symptom persists, refer to the nearest health facility

    Itching/Rashes  

    Isoniazid

    • Reassure patient. 

    • In case of severe itching, refer the patient to the nearest health facility

    Tingling/ burning/ numbness in the hands & feet 

    Isoniazid

    • Refer the patient to the nearest health facility

    Joint Pains 

    Pyrazinamide

    • Reassure patient. 

    • Increase intake of liquids. 

    • If severe, refer the patient to the nearest health facility

    Impaired Vision  

    Ethambutol

    • Refer the patient to the nearest health facility

    Ringing in the ears, Loss of hearing, Dizziness and loss of balance  

    Isoniazid, Rifampicin or Pyrazinamide

    • Refer the patient to the nearest health facility

    Hepatitis: Anorexia/ nausea/ vomiting/ jaundice  

    Isoniazid, Ethambutol,  Rifampicin or Pyrazinamide

    • If patient detected with signs of jaundice, refer the patient to the nearest health facility

     

  • Follow-up of TB patient

    Content

    To know the TB treatment response and to determine that if patient is cured, TB patients are clinically evaluated at the end of every four weeks of treatment, and they are also followed up by performing sputum test at end of each treatment phase (i.e. Intensive phase and Continuation phase)

    TB patients during clinical evaluations are assessed to

    • Identify possible adverse reactions to medications;
    • Check for any comorbid conditions;
    • Weight change;
    • monitor adherence; and determine treatment efficacy by observing their symptoms

    Although each patient responds to treatment at a different pace, all TB symptoms should gradually improve and eventually go away.

    Patients whose symptoms do not improve during the first 2 months of treatment, or whose symptoms worsen after improving initially, should be re-evaluated for adherence issues and development of drug resistance.

  • Long Term Post-treatment follow up of TB patients

    Content

    After completion of TB treatment, all patients should be followed up at the end of

    • 6 months,
    • 12 months,
    • 18 months &
    • 24 months

    TB patients at the follow up should be screened for any clinical symptoms and/or cough. If found positive on screening, then sputum microscopy and/or culture should be considered. This is important in detecting the recurrence of TB at the earliest.

    After completion of TB treatment, if the patient has not developed any clinical symptoms and/or cough and also if the microscopy remains negative during their follow up, then the patient is considered as “Relapse Free Cure from TB.”

     

  • Drug-Resistant Tuberculosis(DR-TB)

    Content

    What is Drug-Resistant Tuberculosis?

    • Drug-Resistant TB occurs when bacteria become resistant to the drugs used to treat TB. This means that the drug can no longer kill the TB bacteria.

    • Multidrug-resistant TB (MDR TB) is a type of DR-TB where TB bacteria is resistant to both Isoniazid and Rifampicin, the two most potent anti-TB drugs.

                                   Figure: High Risk for Drug-Resistant Tuberculosis (DRTB)

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  • Adverse Drug Reactions(ADRs) to Second Line Treatment

    Content

    Common Adverse events to second line treatment are as below

    Figure: Adverse Drug Reaction to Second line drugs

     

    Adverse events should be identified, monitored and be referred to

    • Nearest treating doctor for minor symptoms or
    • District DR-TB Centres for major symptoms

    If required, hospitalization can be done at the District DR-TB Centers where inpatient facility is available or referred to a Nodal DRTB Centre for admission

     

  • TB Infection

    Content

    • TB Infection (or previously known as Latent TB infection) is a stage in between uninfected and having active TB. In this stage the person has no symptoms and can only be identified using laboratory tests.

    • The vast majority of infected people may never develop TB disease. However, to achieve TB elimination, it is important to treat TB infection in people at risk of developing active TB disease.

    • It is a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifested active TB.

    • There is no single acceptable/reliable test for direct identification of Mycobacterium tuberculosis infection in humans. Tuberculin Skin Test (TST) and Interferon-gamma release assay (IGRA) are commonly used tests for identifying TB infection.

    Resources:

     

  • Regimen for TPT

    Content

    The following TPT treatment options are recommended under NTEP once active TB has been ruled out:

     

     

    6H

    3HP

    Medicines

    Isoniazid

    Isoniazid + rifapentine

    Duration (months)

    6

    3

    Interval

    Daily

    Weekly

    Doses

    182

    12

    Pregnant women

    Safe for use

    Not Known

     

    Post-treatment TPT for PLHIV: In patients previously treated for TB, post-treatment TPT has been considered in view of the 5-7 times higher risk of recurrence of TB among PLHIV and nearly 90% of these due to re-infection. Thus, all CLHIV/PLHIV who had successfully completed treatment for TB disease earlier should receive a course of TPT after completing treatment of TB.

     

    Resources 

     

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