Treatment of susceptible TB

Clinical description

• Susceptible TB is treated with first-line drugs: Rifampicin (R), Isoniazid (H), Ethambutol

(E), Pyrazinamide (Z) and Streptomycin (S). The first four oral drugs (RHZE) come as an FDC tablet. Streptomycin (S) is a first line injectable drug used for TB meningitis.

• Patients should not be admitted in the ward or hospital for administration of TB drugs

except where they are too sick or unable to walk.

• TB drugs should be provided on ambulatory basis in all facilities.

Table 7.1-1: Dosages of FDC formulations of first line anti-TB drugs for adults Adults Initial phase 2 months Continuation phase 4months Body [RHZE] [R150/H75/Z400/E275] [RH] [R150/H75] weight in kg Number of tablets Number of tablets 30-37 2 2 38-54 3 3 55-74 4 4 75 and over 5 5 52 National Tuberculosis Control Programme Table 7.1-2: Dose and regimen of anti-TB drugs for children Children Initial phase 2 months Continuation phase 4 months [RHZ](R60/H30/ Z150) E100 [RH] (R60/H60)

Body weight in kg Number of tablets or Number of tablets Number of tablets or sachets sachets or sachets <7 1 1 1 8-9 1.5 1.5 1.5 10-14 2 2 2 15-19 3 3 3 20-24 4 4 4 25-29 5 5 5 Key facts

• Patient weight should be monitored each month, and doses adjusted if weight

changes from one weight band to another are observed during the treatment.

• If the patient continues to lose weight while on treatment, they should undergo a

detailed review by a clinician.

• New smear-positive PTB patients treated with first line drugs should submit a

sputum sample for smear microscopy on completion of the intensive phase.

• Xpert MTB/RIF should not be used to monitor response to treatment in TB patients.

National Tuberculosis Control Programme 53 Table 7.1-3: Selecting a TB treatment regimen Recommended TB TB patient type Additional action(s)

treatment regimen Low risk of being Treat as new: Do rapid DST if the case is from presumptive DR-TB patient 2(RHZE)/4RH high TB risk setting Do rapid DST before If patient is too sick or DST result making decision delays, refer the patient to MDR- Contact of known MDR-TB on the appropriate TB treatment centre for evaluation case regimen and need for empirical treatment New with second line drugs 9RZE Do rapid DST if sputum smear remains positive at or after two INH resistant TB case months of treatment or if smear reverts to positive after being negative.

Do rapid genotypic On the basis of the drug DST before making susceptibility profile, a standard decision on the first-line treatment regimen appropriate regimen (2HRZE/4HR) can be repeated if no resistance is documented Previously In patients who require treated TB retreatment9 If RR is present, an MDR-TB regimen should be prescribed according to the national treatment guideline

• Patient with confirmed Treat with full Refer patient to drug-resistant-TB

DST result of, at least, course of second- register and unit RR-/ RR, or line treatment MDR-/ • TB patient for whom XDR-TB panel team decided to cases start empiric full course second-line drug treat- ment Continue same Assess the treatment response to Transfer in treatment regimen decide on the need for DST 9 Guideline for the treatment of drug susceptible tuberculosis and patient care.2017 update. Geneva; World Health Organization. 2017. License CCBY-NC-SA3.0 IGO.

54 National Tuberculosis Control Programme