Tuberculosis - Treatment guidelines

National TB-Control:

• Disease Class: Pulmonary (PTB) , Extra Pulmonary (EPTB)
• Category of Rx:

  Category	Remark
  Category 1	New smear+, New smear Neg c extensive parenchymal involvement, con-comitant HIV or severe EPTB, Clinicians decision
  Category 2	Prev. treated smear+ (Relapse / default / Rx failure)
  Category 3	New smear Neg PTB other than Category1. Less severe EPTB.
  Category 4	Chr. and MDR - TB (still sputum+)

• Type of Pat: New/Relapse/Failure/Rx after Default/Other

Drug dosage (First line drugs)

H(5), R(10), E(15), S(15), Z(25) mg/kg BW

Special conditions:

• Pregnancy : DO NOT USE STM., All others - OK.
• Breast Feeding : All OK, Refer Kid for INH Prophylaxis.
• Oral Contaceptive: Avoid. (contraceptive failure+).
• Liver Disease : In CLD NO PZA, give 9RHE or 9RE or 2SHE/10HE. In Acute Hepatitis : NO DRUG or SE for 3 mths.
• Renal Failure : H,R,Z : OK (metabolized in Liver), while S,E excreted by Kid. Safe is 2HRZ/4HR
• HIV : Thioacetazone is contraindicated.

WHO Guidelines - 2017

• In patients with drug-susceptible pulmonary TB, 4-month fluoroquinolonecontaining regimens2 should not be used and the 6-month rifampicin-based regimen 2HRZE/4HR remains the recommended regimen (Strong recommendation, moderate certainty in the evidence)
• The use of fixed-dose combination (FDC) tablets is recommended over separate drug formulations in treatment of patients with drug-susceptible TB (Conditional recommendation, low certainty in the evidence).
• In all patients with drug-susceptible pulmonary TB, the use of thrice-weekly dosing is not recommended in both the intensive and continuation phases of therapy, and daily dosing remains the recommended dosing frequency (Conditional recommendation, very low certainty in the evidence)
• The use of adjuvant steroids in the treatment of extrapulmonary TB disease:
  • In patients with TBM, an initial adjuvant corticosteroid therapy with dexamethasone or prednisolone tapered over 6-8 weeks should be used (Strong recommendation, moderate certainty in the evidence).
  • In patients with tuberculous pericarditis, an initial adjuvant corticosteroid therapy may be used (Conditional recommendation, very low certainty in the evidence)
• The empirical use of the WHO category II regimen in patients who require retreatment for TB: In patients who require TB retreatment, the category II regimen should no longer be prescribed and drug-susceptibility testing should be conducted to inform the choice of treatment regimen (Good practice statement).