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Under the National TB Elimination Program (NTEP), Drug-resistant TB (DR-TB) patients receive standardized DR-TB treatment boxes (called Patient-wise Boxes - PWB) for each month. These boxes are either with the health facility nearest to DR-TB patients (DOT centre) or with the treatment supporter who is involved in the care of DR-TB patients.
Steps involved in the preparation of second-line drug boxes for DR-TB patients:
The treatment algorithm for Multidrug-resistant/ Rifampicin-resistant TB (MDR/ RR-TB) patients is a part of an integrated diagnostic and treatment algorithm under Programmatic Management of Drug-resistant Tuberculosis (PMDT).
The Drug-resistant TB (DR-TB) treatment process for all DR-TB patients follows a care cascade.
The two methods available for laboratory diagnosis of drug resistance/ susceptibility are as follows:
Figure: Laboratory Diagnosis Methods: Drug Resistance Testing (DRT) and Drug Susceptibility Test (DST)
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The term probable Drug-resistant TB (DR-TB) would be applied to children where DR-TB is clinically suspected strongly but there is no bacteriologic confirmation and the decision regarding diagnosis and initiation of treatment is taken by the Nodal/ District DR-TB (N/DDR-TB) committee.
The patient-centred care approach is the practice of caring for patients (and their families) in ways that are meaningful and valuable to the individual patient.
The severity of TB disease is crucial for management strategies and treatment outcomes.
The National TB Elimination Programme (NTEP) follows an integrated algorithm for screening and ruling out active Tuberculosis (TB) among Household Contacts (HHCs) of Drug-resistant Tuberculosis (DR-TB) patients.
Figure: Integrated Algorithm for Screening and Ruling out Active TB among HHCs of DR-TB Patients; Source: Guidelines for PMDT in India, 2021, p118.
The suggested treatment regimen covering maximum non-Mycobacterium Tuberculosis (NTM) mainly Mycobacterium Avium Complex (MAC) is as follows:
Intensive Phase (IP) is for 3 months and can be extended to a maximum of 6 months with all four drugs.
It is very important that medical care continues and the patient is not abandoned once the therapy has been suspended. Several supportive measures can be used for this.
Dyspnoea, and to a much lesser extent pain, are among the most distressing symptoms in the last stages of the disease. Thus, access to opioids and other controlled medicines is fundamental for delivering high standards of palliative and end-of-life care to patients with Multidrug-resistant Tuberculosis (MDR-TB).
The details on palliative care supportive measures are as below: