3. PULMONARY TB SUSPECT?
• Cough of 2 weeks or more with/without
other symptoms
• Contacts of smear-positive TB patients
having cough of any duration.
• Suspected/confirmed EPTB having cough
of any duration.
• HIV positive patient having cough of any
duration.
5. COUGH FOR 2 WEEKS OR
MORE
TWO SPUTUM
SMEARS
1 or 2 2 NEGATIVES
POSITIVES
ANTIBIOTICS FOR 10 – 14
SMEAR + PTB DAYS
COUGH PERSISTS
ATT
REPEAT 2 SPUTUM SMEARS
1 OR 2 POSITIVES 2 NEGATIVES
SMEAR + PTB XRAY CHEST
MANTOUX
ATT
S/O TB NOT S/O TB
SMEAR - PTB NON-TB
ATT
9. TRADITIONAL
CLASSIFICATION
FIRST LINE DRUGS:
INH (H)
RIFAMPICIN (R)
PYRAZINAMIDE (Z)
ETHAMBUTOL (E)
STREPTOMYCIN (S)
SECOND LINE DRUGS:
AMIKACIN, KANAMYCIN
FLUOROQUINOLONES
PAS, CYCLOSERINE
10. RECENT WHO CLASSIFICATION
GROUP 1 (FIRST LINE ORAL AGENTS)
• INH
GROUP 2 (INJECTABLE AGENTS)
• KANAMYCIN
GROUP 3 (FLUOROQUINOLONES)
• LEVOFLOXACIN
GROUP 4 (ORAL BACTERIOSTATIC AGENTS)
• ETHIONAMIDE
GROUP 5 (AGENTS WITH UNCLEAR EFFICACY)
• LINAZOLID, AMX-CLV
11. ANTI-TB DRUGS USED
IN RNTCP
FIRST LINE DRUGS:
INH (H)
RIFAMPICIN (R)
PYRAZINAMIDE (Z)
ETHAMBUTOL (E)
STREPTOMYCIN (S)
SECOND LINE DRUGS:
AMIKACIN, KANAMYCIN,
FLUOROQUINOLONES,
CAPREOMYCIN,
ETHIONAMIDE
PAS, CYCLOSERINE, etc…
13. CATEGORIZATION IS BASED ON
• History of patient, including
history of any previous treatment
for TB
• Sputum smear examination
results from an approved DMC
• Chest X-ray report if the case
warrants radiographic
examination
• Other supporting investigation
reports, if any
14. FACTORS TO BE MENTIONED
IN RNTCP CARD
• Disease classification
(PTB / EPTB)
• Type of case
(NEW / TREATED)
• Sputum smear result
smear + / smear --
• Severity of illness
• History of previous
treatment
15. FACTORS TO BE MENTIONED
IN RNTCP CARD
• Details of X-ray
• Chemoprophylaxis for
contacts aged ≤ 6 years
• HIV related data
• Treatment outcome with
date
• Remarks
16. • CATEGORY I
• CATEGORY II DOTS
• CATEGORY III
• CATEGORY IV
DOTS PLUS
• CATEGORY V
17. • NEW
-> CATEGORY I
-> CATEGORY III DOTS
• PREVIOUSLY
TREATED
-> CATEGORY II
• CATEGORY IV
DOTS PLUS
• CATEGORY V
18. WHAT IS DOTS ?
• DIRECTLY OBSERVED
TREATMENT STRATEGY
• SHORT COURSE
CHEMOTHERAPY
• INTERMITTENT REGIMEN
• INCLUDES
1. NEW
2. PREVIOUSLY TREATED
19. WHAT IS DOTS PLUS ?
• IN RNTCP TO ADDRESS THE MDR
TB DIAGNOSIS AND MANAGEMENT
• DAILY DOT EXCEPT SUNDAY
• INCLUDES
1. CATEGORY IV
2. CATEGORY V
20. WHAT IS NON DOTS ?
• RARE TB PATIENTS MAY
NEED NON RIFAMPICIN AND
NON PYRAZINAMIDE
REGIMEN
• DAILY REGIMEN
• NOT OBSERVED
• 2 SHE + 10 HE
25. FOLLOW-UP SCHEDULE FOR
SPUTUM EXAMINATION
• At the end of the intensive phase, the
extended intensive phase (if applicable),
• Two months into the continuation phase
and
•
• At the end of treatment.
• NEW PATIENT 0, 2, 4, 6 MONTHS
• PREVIOUSLY 0, 3, 5, 8 MONTHS
TREATED
26. OUTCOME IN DOTS
• CURED
• TREATMENT COMPLETED
• DEFAULTED
• DIED
• TRANSFERRED OUT
• FAILURE
• SWITCHED TO DOTSPLUS
28. MULTIDRUG RESISTANT TB
(MDR-TB)
MDR TB SUSPECT:
• NSP WHO REMAINS SMEAR+ @ 5 MONTHS
OF RX
• NSN WHO BECOMES SMEAR+ @ 5 MONTHS
OF RX
• PREVIOUSLY TREATED, SMEAR + ON 4 TH MONTH
• CLOSE CONTACTS OF MDRTB PATIENTS WITH
PTB+
MDR TB PATIENT:
AN MDR TB SUSPECT WHOSE SPUTUM IS
CULTURE POSITIVE FOR MTB THAT ARE IN VITRO
RESISTANT TO H & R WITH OR WITHOUT
RESISTANT TO OTHER DRUGS FROM AN RNTCP
ACCREDITED LABORATORY.
29.
30. EXTENSIVELY DR TB
(XDR TB)
• IN VITRO RESISTANCE TO H, R, ANY
OF SECOND LINE INJECTABLE
AMINOGLYCOSIDES AND ANY ONE
OF FLUOROQUINOLONES.
• NO STANDARD REGIMEN AVAILABLE
• SHOULD BE TREATED ACCORDING
TO CULTURE REPORTS
31. EXTREME DR TB / TOTAL DR TB
(XXDR TB / TDRTB)
• RESISTANT TO ALL FIRST-
AND SECOND-LINE DRUGS
• TILL NOW NO TREATMENT
AVAILABLE (possible)
32. CATEGORY IV (DOTS PLUS)
• MULTI DRUG RESISTANT TB (MDR TB)
• RIFAMPICIN MONORESITANCE
REGIMEN
6(9) Km Lvx Eto Cs Z E
FOLLOWED BY 18 Lvx Eto Cs E
DURATION
24 – 27 MONTHS
33. CATEGORY V (DOTS PLUS)
• EXTENSIVELY DRUG RESISTANT TB
(XDR TB)
REGIMEN
6(12) INTENSIVE PHASE FOLLOWED
BY 18 CONTINUATION PHASE
(Cm, PAS, Mfx, Cfz, Lzd, Amx/clv, Clr, Thz)
DURATION
24 -- 30 MONTHS
35. SUMMARY
DIAGNOSIS OF PTB
• DURATION OF COUGH
3 WEEKS 2 WEEKS
• NUMBER OF SPUTUM SMEARS TO BE
COLLECTED
3 SMEARS 2 SMEARS
• NUMBER OF + SMEARS REQUIRED FOR
DX OF PTB+
2 SMEARS 1 SMEAR
36. SUMMARY
TREATMENT OF PTB
• CATEGORY III HAS BEEN
PHASED OUT
• NEW (DOTS)
• PREVIOUSLY TREATED (DOTS)
• CATEGORY IV FOR MDRTB
• CATEGORY V FOR XDRTB