Treatment Regimens
Goals and Objectives of treatment
- To render the patient non-infectious, break the chain of transmission, and decrease the pool of infection.
- To decrease case fatality & morbidity by ensuring relapse-free cure.
- To minimise and prevent the development of drug resistance.
Directly Observed Treatment (DOT)
The National Tuberculosis Elimination Program envisages the provision of tuberculosis treatment under DOT. DOT is a supportive mechanism that ensures the best possible results in the treatment of TB. Here a treatment supporter helps the patient in taking the treatment and ensures treatment adherence. DOT ensures that patients receive the right drugs, in the right doses, at the right intervals, and for the right duration.
Treatment Regimen for Drug Susceptible Tuberculosis (DSTB)
For all TB patients whether being treated in the public or private sector, clinicians should follow Standards for TB care in India (STCI) guidelines. The Treatment for DSTB is given in two phases: the intensive phase and the continuation phase. Intensive Phase (IP): Consists of 8 weeks (56 doses) of isoniazid (H), rifampicin (R), pyrazinamide (Z), and ethambutol (E) given under direct observation in daily dosages. Continuation Phase (CP): Consists of 16 weeks (112 doses) of isoniazid, rifampicin, and ethambutol in daily dosages. The CP may be extended by 12-24 weeks in certain forms of TB like CNS TB, Skeletal TB, Disseminated TB, etc. based on the clinical decision of the treating physician on a case-to-case basis.
Treatment Regimen for Drug-Resistant Tuberculosis (DRTB)
The National Tuberculosis Elimination Program envisages the provision of tuberculosis treatment under DOT. DOT is a supportive mechanism that ensures the best possible results in the treatment of TB. Here a treatment supporter helps the patient in taking the treatment and ensures treatment adherence. DOT ensures that patients receive the right drugs, in the right doses, at the right intervals, and for the right duration.
- All oral High dose mono/poly Drug Resistant TB regimen: It is of 6 months with no separate Intensive Phase/Continuation Phase.
- Shorter Multi-Drug Resistant TB regimen: It is of 9-11 months with 4-6 months of Intensive Phase containing injectables and 5 months of the Continuation Phase.
- All oral longer Multi-Drug Resistant TB regimen: It is of 18-20 months with no separate Intensive Phase / Continuation Phase.
Long Term Follow-up
After completion of treatment, all patients, whether suffering from DSTB or DRTB, should be followed up clinically at the end of 6, 12, 18 & 24 months. In the presence of any clinical symptom (e.g., cough), sputum microscopy and/or culture of the biological specimen should be considered. This is important in detecting the recurrence of TB at the earliest.
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