2. Patient wise boxes with multiblister combipack

3. Phases of Treatment
Intensive Phase
• Meant to kill as many bacilli rapidly as possible
Continuation Phase
• Aimed to sterilize smaller number of dormant/persisting
bacilli to prevent relapse.

4. • New smear positives
• New sputum smear negative
• New extra-pulmonary
• New others
Category I
(New)
Red Box
•IP= 2 (HRZE)3
•CP=4 (HR)3

5. Blue Box
•IP=2 (HRZES)3+1(HRZE)3
•CP= 5 (HRE)3
• Smear positive relapse
• Smear positive failure
• Smear positive treatment
after default
• Others
Category II
(Previously
treated)

6. Follow Up
• Two sputum smears are examined each time during follow up.
1. As early morning sample
2. Spot sample
Category SS –ve at the
end of IP
SS +ve at the
end of IP
I 2,4,6th month 2,3,5,7th month
II 3,5,8th month 3,4,6,9th month

7. 7th
month
6th
month
5th
month
4th
month
3rd
month
2nd
month
At the
end
of IP
Both
SS -ve
Patient
put to
CP
SS exam
repeated
CP
continued
SS exam
repeated
Either
of
them
+ve
IP
extended
to 1
month
SS +ve
/ -ve
Patient
put to
CP
-ve SS
CP
continued
SS exam
repeated
+ve SS Treatment
failure
Category
II

8. 9th
month
8th
month
6th
month
5th
month
4th
month
3rd
month
At the
end of
IP
Both SS
-ve
Pt. put
to CP
SS exam
repeated
Contd
CP
SS exam
repeated
Either
of them
+ve
IP
extended
to 1
month
SS +ve /
-ve
Pt. put
to CP
SS exam
repeated
SS exam
repeated

9. Drug Resistance
Primary/ Pre-treatment resistance:
• The resistance shown by the bacteria in a patient, who
has not received the drug in question before.
• Due to infection by drug resistant bacilli.
Secondary / Acquired resistance:
• The resistance shown by the bacteria which were
sensitive to the drug at the start of the treatment but
became resistant to the particular drug during the
course of treatment.

10. Multi Drug Resistant (MDR) Tuberculosis
 According to WHO, MDR strain is one that is at least
resistant to Rifampicin and Isoniazid, with or without
resistance to other anti-TB drugs.
CATAGORY IV (DOTS-PLUS)
Treatment of MDR-TB
Indication:
1. History of prior treatment where smear positive
cases found even after repeated treatment courses,
category II failure.
2. Close exposure to possible source cases,
confirmed to have drug resistant TB.
Diagnosis must be confirmed by culture and Drug
Sensitivity Testing (DST)

11. RNTCP Regimen
IP= 6(9) Km Ofx Eto Cs Z E + CP= 18 Ofx Eto Cs E
Extensively Drug Resistance Tuberculosis
• Extensively drug resistance (XDR) is defined as the strain
which is resistant to:
1. at least Rifampicin and INH (i.e. MDR)
2. A Fluoroquinolone, and
3. one or two following second line injectable drugs:
Amikacin, Capreomycin, Kanamycin

12. Standardized regimen for XDR-TB:
Intensive phase:
• Capreomycin
• PAS
• Moxifloxacin
• Linezolid
• Clofazimine
• Amoxicillin/ Clavulinate
Continuation phase:
• PAS
• Moxifloxacin
• Isoniazid
• Clofazimine
• Linezolid
• Amoxicillin/ Clavulinate
6-12 months
18 months
V

13. Teratogenic Drugs:
Avoided
during Pregnancy
Alternative drugs, i.e. Ethambutol must be used instead of
Streptomycin.
First line Second line
Streptomycin Ethionamide
Protionamide
Fluoroquinolones

14. Non DOTS Regimen
Indication:
 When there is adverse reaction to drugs used in short
course chemotherapy.
 When patient cannot comply with the DOTS regimen.
• New smear positive
• Pulmonary seriously ill patients
• Extra pulmonary seriously ill
patients
Non-DOTS regime
1 (ND1):
2 (S H E) + 10 (H E)
• New smear negative
• Pulmonary not seriously ill patients
• Extra pulmonary not seriously ill
patients
Non-DOTS regime
2 (ND2):
12 (H E)