Tuberculosis is a prevalent disease in the developing countries with severe consequences specially in children who are more likely to develop dissemination.
Treatment consits of 2 phases-
Initial Intensive Phase- Duration is generally 2 months and it achieves rapid killing of mycobacteria. Infectious patients are rendered non-infectious by 2 weeks. Majority of patients turn sputum positive to negative by 2 months of therapy. DOTS currently focuses more on Intensive phase as the drug resistance likelihood is higher at this phase when mycobateria are more.
Continuation phase- Usually 4-5 months durations. Fewer drugs are used but for a longer duration in this phase. Drugs eliminate the remaining bacilli including persister thus preventing TB repalse. If DOTS is not possible in this phase a close supervision is instituted.
Standard code of Treatment-
Each ATT drug has an abbreviation namely-
And two phases as described earlier.
TB TREATMENT CATEGORY PATIENT
Category 1- new sputum smear-positive PTB,sputum negative PTB and extra pulmonary TB.
Category 2 -relapse,treatment failure,treatment after default (interrupted treatment)
Severe Extra pulmonary TB– meningitis, miliary, pericarditis, peritonitis,, bilateral or extensive pleural effusion, spinal , intestinal , genitor-urinary.
Less Severe Extrapulmonary TB-lymph node,pleural effusion (unilateral),bone (excluding spine), peripheral joint,adrenal gland
Following regimen is recommended by Nepal Tuberculosis Protocol– Click for full image