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  • Categorization of DSTB Treatment Regimen

    Content

    Daily Regimen is prescribed for Drug Sensitive TB patients (DSTB), where the patient needs to consume the FDC formulation daily.

    Daily Regimen comprises the first line Anti TB drugs based on

    • Age: Adult/ Pediatric
    • Weight of the patient: Weight Bands

    Age: Based on age, patients are categorized into

    • Adults: The patient's age should be greater than 19 years
    • Paediatrics: Patient's age up to 19 years and weight less than 39 Kgs

    Weight Bands: 

    • Treatment dosages are based on TB patients’ weight.
    • A weight band category is defined for Adults and Pediatric patients separately, and FDC are issued based on that weight category.

  • 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.
     

  • Treatment Regimen for DSTB - Pediatrics

    Content

    Intensive Phase (IP)

    Consists of eight weeks (56 doses) of HRZ in daily dosages as per weight of patient.

    Ethambutol (E) is given separately for children to monitor ophthalmic side effects.

     

    Continuous Phase (CP)

    Consists of 16 weeks (112 doses) of HRE in daily dosages as per the weight of the patient.

    In Pediatric, there are six weight bands’s as shown in the table below. The table also indicates the number of FDC tablets  that has to be consumed in each weight band

     

    Weight Band category

     

    Fixed-Dose Combinations (FDCs)
     

    Intensive phase (IP)

    (HRZE - 75/150/400/275)

    Continuation phase (CP)

    (HRE - 75/150/275)

    4-7 kgs

    		 1 1

    8-11 kgs

    		 2 2

    12-15 kgs

    		 3 3

    16-24 Kgs

    		 4 4

    25-29 Kgs

    		 3 + 1A 3 + 1A

    30-39 Kgs

    		 2 + 2A 2 + 2A

     

    Regular monthly follow-up of the paediatric patient needs to be done and if the patient weight crosses the range of the weight band during the treatment, then the weight band of the patient should be changed immediately.

    Children above 39 kg shall usually be adolescents, the drug dosage requirement for them would be similar to adults

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  • DS-TB Treatment – Patient Flow

    Content

    Community Health Volunteers(CHVs) have to refer the presumptive cases identified based on the r symptom screening to the nearest NTEP health facility for further investigation. Once Diagnosed with TB, the TB patients are initiated on the first-line TB treatment. Patients are also offered NAAT within a maximum of 15 days to rule out any drug resistance. If no drug resistance is detected, then the patient continues on the first-line TB treatment. TB patients are then clinically evaluated every month to check the progress of TB treatment. 

    The treatment duration of TB is divided into two phases - The Intensive Phase(IP) and the Continuation Phase(CP). Post-treatment completion, patients are then evaluated at intervals of 6,12,18 and 24 Months to ensure a relapse-free TB cure for the patient.

    Figure: DSTB Treatment Flow

     

  • 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