National Tuberculosis Control Program – key policies
£ Case finding – direct Sputum Microscopy and X-ray examination of TB symptomatics who are negative after 2 or more sputum exams
£ Treatment – shall be given free and on an ambulatory basis, except those with acute complications and emergencies
£ Direct Observed Treatment Short Course – comprehensive strategy to detect and cure TB patients.
¡ Category and Treatment Regimen
¡ Category 1- new TB patients whose sputum is positive; seriously ill patients with severe forms of smear-negative PTB with extensive parenchymal involvement (moderately- or far- advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.)
¡ Category 2-previously-treated patients with relapses or failures.
¡ Category 3 – new TB patients whose sputum is smear-negative for 3 times and chest x-ray result of PTB minimal
Category 1-
¡ new TB patients whose sputum is positive; seriously ill patients with severe forms of smear-negative PTB with extensive parenchymal involvement (moderately- or far- advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.)
Intensive Phase (given daily for the first 2 months)- Rifampicin + Isioniazid + pyrazinamide + ethambutol.
If sputum result becomes negative after 2 months, maintenance phase starts. But if sputum is still positive in 2 months, all drugs are discontinued from 2-3 days and a sputum specimen is examined for culture and drug sensitivity. The patient resumes taking the 4 drugs for another month and then another smear exam is done at the end of the 3rd month.
Maintenance Phase (after 3rd month, regardless of the result of the sputum exam)-INH + rifampicin daily
Category 2-previously-treated patients with relapses or failures.
Intensive Phase (daily for 3 months, month 1,2 & 3)-Isioniazid+ rifampicin+ pyrazinamide+ ethambutol+ streptomycin for the first 2 months Streptomycin+ rifampicin pyrazinamide+ ethambutol on the 3rd month. If sputum is still positive after 3 months, the intensive phase is continued for 1 more month and then another sputum exam is done. If still positive after 4 months, intensive phase is continued for the next 5 months.
Maintenance Phase (daily for 5 months, month 4,5,6,7,& 8)-Isionazid+ rifampicin+ ethambutol
Category 3 – new TB patients whose sputum is smear-negative for 3 times and chest x-ray result of PTB minimal
¡ Intensive Phase (daily for 2 months) – Isioniazid + rifampicin + pyrazinamide
¡ Maintenance Phase (daily for the next 2 months) - Isioniazid + rifampicin
Stop TB ; Do it with DOTS
§ Advocacy is a planned and continuous effort to inform people about issue and instigate change. Advocacy usually takes place over an extended period of time and includes a variety of strategies to communicate a specific message.
§ TB is the number one infectious killer in the world.
§ One TB suspect can infect another 10 healthy persons