Anti tubercular treatment regimen

  • RNTCP ( Revised National Tuberculosis Control Programme) is an application of WHO recommended strategy of DOTS in India. 
  • It is largely based on the research done at National Tuberculosis Institute, Bangalore and Tuberculosis Research Centre, Chennai.
OBJECTIVES:
  1. Detecting at least 70% of sputum positive tuberculosis patients in the community.
  2. Curing at least 85% of the newly detected sputum positive cases.
COMPONENTS OF DOTS (Directly observed treatment strategy)
  1. Political and administrative commitment at all levels.
  2. Diagnosis through sputum microscopy
  3. Uninterrupted supply of short course chemotherapy drugs.
  4. Direct observation of drug intake ( DOTS)
  5. Systematic monitoring, evaluation and supervision at all levels.
TREATMENT SCHEDULE:
  • Category-1: 
  1. Newly diagnosed sputum positive pulmonary tuberculosis
  2. Sputum negative pulmonary tuberculosis with extensive parenchymal involvement.
  3. Severe form of extrapulmonary tuberculosis
  • Category-2
  1. Treatment failure cases
  2. Relapse cases
  3. Return after interruption
  • Category-3
  1. Sputum negative pulmonary tuberculosis with minimal involvement
  2. Less severe form of extrapulmonary tuberculosis
  • To be termed as cured a patient who was initially smear positive and completed treatment, should have a negative smear result on at least 2 occasions of which one should be at treatment completion.
  • A patient is branded as treatment complete if he was either sputum negative to begin with or sputum positive and completed the treatment but with no or only one negative smear during continuation and none at the end of treatment.
DRUG REGIMEN:
  • Category- 1: 2(H3 R3 Z3 E3) 4 ( H3 R3 )
  • Category- 2: 2( S3 H3 R3 Z3 E3)+ 1( H3 R3 Z3 E3 ) 5 ( H3 R3 E3)
  • Category- 3: 2( H3 R3 Z3 ) 4 ( H3 R3 )
  1. H= INH 600mg, 
  2. R= Rifampicin 450mg,
  3. Z= Pyrazinamide 1500mg,
  4. E= Ethambutol 1200mg, 
  5. S= Streptomycin 750 mg
  • Cat 2(H3 R3 Z3 E3) 4 ( H3 R3 ) means initial two months of therapy with INH, Rifampicin,Pyrazinamide and Ethambutol in a thrice weekly schedule followed by INH and rifampicin for a period of 4 months in a thrice weekly schedule
  • Dots Plus regime consist of 6Km Ofx Eto Cs ZE + 18 Ofx Eto CsE
NON DOTS REGIMEN:
  • Daily self administered non-DOTS regime is followed in extremely rare circumstances where there is an adverse reaction to drugs used in the short – course therapy or when the patient is not able to comply with the regimen.
  • The 2 regimes are as given below:
  1. ND1 regime – For new sputum +ve pulmonary seriously ill patients and extrapulmonary seriously ill patients – 2(SHE) + 10(HE) ND2 regime – For sputum -ve pulmonary not seriously ill patients and extrapulmonary not seriously ill patients – 12(HE)
Treatment in the RNTCP (Revised National TB Control Programme)
  • DOTS Medication is to be taken in presence of a health worker
  • Consists of 2 phases –
  • An initial intensive phase and a second continuation phase.
  • The total duration of treatment is 6-9 months.
  • The intensive phase lasts for 2-4 months.
  1. In this phase, a health worker watches as the patient swallows the drugs in his presence. Treatment is given thrice a week on alternate days and every dose is directly observed. The continuation phase lasts for 4-5 months depending on the patient’s response to treatment. 
  2. Continuation phase drugs are given in a multi-blister combipack
  3. In this phase, the first dose of the medicine every week is taken by the patient under direct observation, while the other doses are taken by the patient himself. The patient is requested to bring the previous week’s blister pack when coming to collect the next week’s blister pack.
  • The colour of boxes (containing the drugs for full course of treatment) is according to the category of regimen : -
  1. Category I patients→Red .
  2. Category II patients→ Blue .
  3. Category III patients→ Green
Exam Question
  • Dots Plus regime consist of 6Km Ofx Eto Cs ZE + 18 Ofx Eto CsE
  • To be termed as cured a patient who was initially smear positive and completed treatment, should have a negative smear result on at least 2 occasions of which one should be at treatment completion.
  • ND2 regime – For sputum -ve pulmonary not seriously ill patients and extrapulmonary not seriously ill patients – 12(HE)
  • In DOTS Continuation phase drugs are given in a multi-blister combipack
  • DOTS Medication is to be taken in presence of a health worker
  • Alternate day treatment is recomended in DOTS
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