Treatment of Tuberculosis

on 19.1.08 with 0 comments



  • WHO Recommends Multi drug therapy
  • Objectives
    • To make the patient Non-Infectious as early as possible by killing the dividing bacilli using 3-4 bactericidal agents
    • To prevent evolution of drug resistant bacilli
    • To prevent relapse by killing the dormant forms
    • To reduce the duration of effective therapy

Treatment regimens
  • Long Course (Conventional , 18 months)
    • Poor compliance
    • Less Effective
    • Not Recommended anymore

  • Short course (6-9 months)
    • Initial Intensive Phase (2-3 months)
      • to render patient non-contagious
      • Intensive treatment with 3-4 drugs daily or thrice weekly
      • Isoniazid 300mg +Rifampicin 600mg+ Pyrazimanide 1500mg+ Ethmbutol 1000mg/Streptomycin 1000mg + Pyridoxine 10mg daily for 2 months
    • Continuation Phase (4-6 months)
      • To eliminate the persisters and prevent relapse
      • Two drugs usually Isoniazid and Rifampicin or ethambutol daily or thrice weekly
      • Isoniazid 300mg +Rifampicin 600mg+ Pyridoxine 10mg daily for 4 months

Based on case- definition, a TB patient may fall into any one of the following four categories for treatment. The categories are numbered in order of priority. The highest priority for treatment is Category 1 patients and the lowest priority is Category 4:


  • Category 1: New cases who are smear-positive, or seriously ill patients who are smear-negative or who have extra-pulmonary disease.
  • Category 2: Re-treatment cases including patients with relapse, treatment failure and those who return to treatment after default. Such patients are generally sputum-positive.
  • Category 3: Patients who are sputum-negative, or who have extra-pulmonary TB and are not seriously ill.
  • Category 4: Chronic cases, still sputum-positive after supervised re-treatment

GUIDELINES OF TREATMENT IN REVISED TB CONTROL POLICY
Category I:
This category is recommended with highest priority to the new cases of AFB smear positive pulmonary tuberculosis and other newly diagnosed seriously ill cases with sever
form of TB like, meningitis, disseminated miliary TB, tuberculous pericarditis, perotonitis, bilateral or extensive pleurisy, spinal disease with neurological complications, smear
negative pulmonary tuberculosis, intestinal and genitourinary tuberculosis etc. The regimen consists of the following phases,
  • Initial intensive phase: 2HRZE under strict observation for initial two months
  • Sputum negative-continuation phase therapy for six months
  • Sputum positive-another two intensive therapy
  • Continuation Phase: H & T for six months
  •


Category II

It is for smear positive relapses & failures after Sort course chemotherapy. The cases in this
category are the suspects for H or multiple drugs resistant(MDR).
  • Initial phase: 2HRZES for initial two months then the same regimen for without S for one month, total duration-three months.
  • If sputum negative-continuation therapy
  • If positive-then four drug regimen for 2months and culture sensitivity analysis done.
  • Continuation phase: HRE for 5 months
  • If positive then treated as chronic case.
Category III :
This category consists of eight months treatment regimens for sputum smear negative and Extra Pulmonary cases of TB except for those mentioned in the above or children below
the age of 15 years.
  • Initial intensive phase: HRZ for two months and HAT for six months.
  • If sputum smear is negative -then continuation phase
  • If positive –then reconfirm and repeat category II treatment

Category: Pharmacology Notes

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