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Tuberculosis treatment: general principles and approach Lecturer: Ph.D M.G.Dolynska
Historical background ,[object Object],[object Object],[object Object],[object Object]
The AIMS of treatment of tuberculosis are: ,[object Object],[object Object],[object Object],[object Object],[object Object]
DOTS ( Directly observed treatment short course ), Karel Styblo, 1972 ,[object Object],[object Object],[object Object],[object Object]
The five elements of the expanded DOTS framework are:   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Dosage and abbreviation of essential antituberculosis drugs 30 (20-35) 15 (15-20) Ethambutol (E) 15 (12-18) 15 (12-18) Streptomycin (S) 35 (30-40) 25 (20-30) Pyrasinamide (Z) 10 (8-12) 10 (8-12) Rifampicin (R) 10 (8-12) 5 (4-6) Isoniasid (H) 3 times weekly Daily Recommended dosage (dose range) in md/kg Drug (abbreviation)
Basical treatment regimens   Optional 5 (HRE) 3 Optional 2(HRZES) 3 /1HRZE 3 Preferred 5 HRE VI Preferred 2 HRZES / 1 HRZE VI Previously treated sputum smearpositive PTB: - relapse; - treatment after default  II Optional 4 (HR)3 or 6 HE V Optional  or 2 (HRZE) 3 or 2 HRZE IV Preferred 4 HR 4 (HR)3 Preferred 2 HRZE I New smear-positive patients; new smear-negative PTB with extensive parenchymal involvement; concomitant HIV disease or severe forms of extrapulmonary TB I Continual phase Initial phase Treatment regimen I TB patients Diagnostic category
Basical treatment regimens (continued) WHO/CDS/TB/2003.313 Treatment of tuberculosis:guidelines  for national programmes, third edition. Revision approved by STAG, June 2004 Specially designed standardized or individualized regimens Chronic (still sputum-positive after supervised re-treatment); proven or suspected MDR TB cases. IV Optional 4 (HR)3 or 6 HE Optional 2 (HRZE)3 Preferred 4 HR Preferred 2 HRZE VIII New smear-negative PTB (other than in category I) and less severe forms of extra-pulmonary TB  III Continual phase Initial phase Treatment regimen I TB patients Diagnostic category
Criticism concern with the DOTS strategy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Expanded treatment conception ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Drug resistance   ,[object Object],[object Object],[object Object],[object Object]
Drug resistance ,[object Object],[object Object]
Main resistance types ,[object Object],Resistance mono MDR poly
MDR-TB  prevalence among new cases and countries in which at least one  XDR-TB  case has been reported At the end of  2006  year  XDR-TB  has been detected in 17 countries
Extensively drug resistance (XDR) – main definitions ,[object Object],[object Object]
Second line drugs ,[object Object],[object Object],[object Object]
Classes of second-line antituberculosis drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classes of second-line antituberculosis drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classes of second-line antituberculosis drugs ,[object Object],[object Object],[object Object],[object Object],[object Object]
Classes of second-line antituberculosis drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acceptable regimen for the treatment   of MDR Tuberculosis
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Recovery criteria ,[object Object],[object Object],[object Object]
 
TB and HIV treatment sequence

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Tuberculosis treatment

  • 1. Tuberculosis treatment: general principles and approach Lecturer: Ph.D M.G.Dolynska
  • 2.
  • 3.
  • 4.
  • 5.
  • 6. Dosage and abbreviation of essential antituberculosis drugs 30 (20-35) 15 (15-20) Ethambutol (E) 15 (12-18) 15 (12-18) Streptomycin (S) 35 (30-40) 25 (20-30) Pyrasinamide (Z) 10 (8-12) 10 (8-12) Rifampicin (R) 10 (8-12) 5 (4-6) Isoniasid (H) 3 times weekly Daily Recommended dosage (dose range) in md/kg Drug (abbreviation)
  • 7. Basical treatment regimens Optional 5 (HRE) 3 Optional 2(HRZES) 3 /1HRZE 3 Preferred 5 HRE VI Preferred 2 HRZES / 1 HRZE VI Previously treated sputum smearpositive PTB: - relapse; - treatment after default II Optional 4 (HR)3 or 6 HE V Optional or 2 (HRZE) 3 or 2 HRZE IV Preferred 4 HR 4 (HR)3 Preferred 2 HRZE I New smear-positive patients; new smear-negative PTB with extensive parenchymal involvement; concomitant HIV disease or severe forms of extrapulmonary TB I Continual phase Initial phase Treatment regimen I TB patients Diagnostic category
  • 8. Basical treatment regimens (continued) WHO/CDS/TB/2003.313 Treatment of tuberculosis:guidelines for national programmes, third edition. Revision approved by STAG, June 2004 Specially designed standardized or individualized regimens Chronic (still sputum-positive after supervised re-treatment); proven or suspected MDR TB cases. IV Optional 4 (HR)3 or 6 HE Optional 2 (HRZE)3 Preferred 4 HR Preferred 2 HRZE VIII New smear-negative PTB (other than in category I) and less severe forms of extra-pulmonary TB III Continual phase Initial phase Treatment regimen I TB patients Diagnostic category
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15. MDR-TB prevalence among new cases and countries in which at least one XDR-TB case has been reported At the end of 2006 year XDR-TB has been detected in 17 countries
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22. Acceptable regimen for the treatment of MDR Tuberculosis
  • 23.
  • 24.
  • 25.  
  • 26. TB and HIV treatment sequence