RECENT TB TREATMENT

GUIDELINES
DR VENKATESH
INTRODUCTION

About 1/3 of world population is infected with M.TB, out of which

10-15% will develop disease in their life time.

9.6 million cases world wide , 2.2 million in India.

KD TRIPATHI 8TH EDITION, RNTCP Techinical and operational guidelines for tuberculosis control in india, 2016, global tuberculosis
report 2015, WHO Geneva. HARRISONS 20 TH EDITION.
INTRODUCTION

- Most common cause of death due to infectious disease in india

(600/day)

- In 2012 it was declared as notifiable disease in India.

- RNTCP was launched in 1997 and was revised lastly in 2016.

• KD TRIPATHI 8TH EDITION, RNTCP Technical and operational guidelines for tuberculosis control in India, 2016, global tuberculosis
report 2015, WHO Geneva. HARRISONS 20 TH EDITION.
DEFINITIONS

New A TB patient who has never had treatment for TB or has taken anti-TB
drugs for less than one month.

Relapse A TB patient who was declared cured or treatment completed by

a physician and who reports back to the health facility and is now found to
be sputum smear positive.

• KD TRIPATHI 8TH EDITION, RNTCP Techinical and operational guidelines for tuberculosis control in india, 2016, global tuberculosis
report 2015, WHO Geneva. HARRISONS 20 TH EDITION. K.PARK 24TH EDITION
Treatment after default: A patient, who has received treatment for TB for
a month or more from any source and returns for treatment after having
defaulted i.e., not taken anti-TB drugs consecutively for two months or
more and found to be smear –positive.
Treatment failure Any TB patient who is smear-positive at 5 months or
more after initiation of treatment
Defaulted A Patient after treatment initiation has interrupted treatment
consecutively for >2 months

• KD TRIPATHI 8TH EDITION, RNTCP Techinical and operational guidelines for tuberculosis control in india, 2016, global tuberculosis
report 2015, WHO Geneva. HARRISONS 20 TH EDITION. K.PARK 24TH EDITION
Case definitions - WHO

Tuberculous intrathoracic lymphadenopathy (mediastinal and/or hilar) or

tuberculous pleural effusion,without radiographic abnormalities in the
Lungs, constitutes a case of extrapulmonary TB.

A patient with both pulmonary and extrapulmonary TB should be

classified as a case of pulmonary TB.
DIAGNOSIS

PRESUMPTIVE T.B
1) Cough > 2weeks.
2) fever > 2weeks.
3) weight loss or no weight gain in children.
4) night sweats.
• PASTE
A.T.T – DOTS AND NON DOTS

First line drugs ( group 1)- drugs with high anti tubercular efficacy as well
as low toxicity.
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
Second line drugs – low anti tubercular activity or higher toxicity or both,
and are used when first line drugs cannot be used or to supplement them.
Group ii ( injectable drugs)- streptomycin, kanamycin, amikacin,
capreomycin.
Group iii – fluoroquinolones.
Group iv – ethionamide, protionamide, cycloserine, PAS, rifabutin,
rifapentine.
Group v-( unclear efficacy)- Bedaquiline, clarithromycin, clofazimine,
linezolid, amoxiclav, imipenem/cilastatin.
( group v drugs are reserved for XDR-TB)
CLASSIFICATION BASED ON SENSITIVITY

Drug sensitive TB- Sensitive all first line drugs.

MDR-TB- Resistant to both INH and R with or with out resistant to other
first line drugs.

XDR-TB- A MDR-TB case with resistant to 1 FQ and one injectable.

TREATMENT- DRUG SENSITIVE TB

The 6-month regimen with pyrazinamide can probably be used safely during pregnancy and is recommended by the WHO
and the International Union Against Tuberculosis and Lung Disease.

If pyrazinamide is not included in the initial treatment regimen, the minimal duration of therapy is 9 months
TREATMENT- DRUG SENSITIVE TB- ACCORDING TO RNTCP

SAME AS WHO- ETHAMBUTAL ADDED IN CONTINUTION PHASE ( 4HRE)

BODY WEIGHT HRZE (tab a) HRE ( tab b)

25-39KG 2 2
40-54 kg 3 3
55-69kg 4 4
> Or = 70 5 5
Tab a – H(75mg)+R(150mg)+Z(400mg)+E(275mg).
Tab b – H(75mg)+ R(150mg)+ E( 275mg).
RX - MDR

• MDR-TB has a most rapid course with worse outcome.

Treatment is for longer duration and expensive.
In India 3% of all new cases and 12-17% of retreatment cases.
STANDARD RNTCP REGIMEN FOR MDR-TB BASED ON WHO
RECOMMENDATIONS.
INTENSIVE PHASE( 6-9 months) CONTINUTION PHASE(18months)
1) Kanamycin 1) Levofloxacin
2) Levofloxacin 2) Ethionamide
3) Ethionamide 3) Cycloserine
4) Cycloserine 4) Ethambutol
5) Pyrazinamide
6) Ethambbutal

+ PYRIDOXIN 100mg /day

RIFAMPIN RESISTANT-TB

According to RNTCP and WHO RR-TB should be treated as MDR- TB

MONODRUG RESISTANT TB

•R
• + 2 FIRST LINE DRUGS TO WHICH BACILLI ARE SENSITIVE
• + 1 INJECTABLE SECOND LINE
• + 1 FQ

A Total of 5 drugs with intensive phase of 3-6 months. With total duration
of treatment for 9-12 months.
Polydrug resistant tb

•R
• + 1 FIRST LINE DRUGS TO WHICH BACILLI ARE SENSITIVE
• + 1 second line drug
• + 1 INJECTABLE SECOND LINE
• + 1 FQ

A Total of 5 drugs with intensive phase of 3-6 months. With total duration
of treatment for 9-12 months.
ISONIAZID RESISTANT TB

inhA --- 900 mg/day for a person of 46-70kg

Kat G
EXTENSIVE DRUG RESISTANT TB

Resistant to at least 4 most effective cidal Drugs –

viz- H,R,FQ and one of Km/Am/Cm
Treatment include 7 drugs in intensive phase ( 6-12 months)
6 drugs in continuation phase (18 months)
Daily doses for 46-70 kg body weight
Capreomycin – 1000mg
Moxifloxacin 400 mg
PAS – 12 G
Clofazimine – 200mg
Linezolid 600mg
Amoxi-clav (875+125) – 2 caps in morning + 1 cap in evening.
THANK YOU