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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

     

  • 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)

    Resources:

  • DR-TB Treatment – Patient Flow

    Content

    After getting diagnosed with Drug-Resistant TB(DR-TB), the patient is referred to District DRTB Centre(DDR-TBC) for initiation of treatment. Few clinically complicated cases are referred to the Nodal DRTB Centre(NDR TBC). Since the drugs used for the treatment of DR-TB have significant adverse effects and to rule out any underlying comorbid conditions or radiological or ECG, or biochemical derangements, a Pre-treatment evaluation is done to check eligibility of patients for DR-TB regimen and to identify those patients requiring special attention and regimen modifications before initiating patients on TB treatment.

    After initiation of treatment, patients are monitored every month. If the sputum test is positive during the follow-up, then the sputum sample is sent for further testing, and if needed, the regimen is changed. And if the sputum sample turns out to be negative during follow up sputum test, then the same treatment regimen is continued till treatment completion.

    Post-treatment completion, patients are evaluated at the interval of 6, 12, 18 and 24 months, screened for any clinical signs and symptoms, and, if found suspected, then referred for sputum microscopy and /or culture test.

     

     

    Figure: TB patient flow after being diagnosed with Multi Drug Resistance TB(MDR/RR TB)