RNTCP 2015 BY Dr Deepak Kr Nirwal Kalyani Hospital ,Kiratpur Bijnor

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RECENT GUIDLINES FOR RNTCP

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By: drksudhakar (68 month(s) ago)

sir i am dr.k.sudhakar neurourgeon can you plz allow me to download your iv induction agents ppt

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Slide 1:

RNTCP Presented By:- Dr Deepak kr Nirwal Resident Anaesthesia Department SBH GMC ; Dhule

pulmonary TB SUSPECT?:

pulmonary TB SUSPECT?

pulmonary TB SUSPECT?:

Cough of 2 weeks or more with/without other symptoms Contacts of smear-positive TB patients having cough of any duration. Suspected/confirmed EPTB having cough of any duration. HIV positive patient having cough of any duration. pulmonary TB SUSPECT?

Diagnostic Algorithm for Pulmonary TB:

Diagnostic Algorithm for Pulmonary TB

DIAGNOSTIC AND TREATMENT PROTOCOL:

DIAGNOSTIC AND TREATMENT PROTOCOL

TREATMENT OF TB UNDER RNTCP:

TREATMENT OF TB UNDER RNTCP

WHAT IS THE MOST POTENT ANTI TB DRUG?:

WHAT IS THE MOST POTENT ANTI TB DRUG? PAST  ISONIAZID PRESENT  RIFAMPICIN FUTURE  MOXIFLOXACIN RESEARCH  TRANSITMYCIN

CLASSIFICATION OF ANTITUBERCULAR DRUGS:

CLASSIFICATION OF ANTITUBERCULAR DRUGS

TRADITIONAL CLASSIFICATION:

TRADITIONAL CLASSIFICATION FIRST LINE DRUGS: INH (H) RIFAMPICIN (R) PYRAZINAMIDE (Z) ETHAMBUTOL (E) STREPTOMYCIN (S) SECOND LINE DRUGS: AMIKACIN, KANAMYCIN FLUOROQUINOLONES PAS, CYCLOSERINE

RECENT WHO CLASSIFICATION:

RECENT WHO CLASSIFICATION GROUP 1 (FIRST LINE ORAL AGENTS) INH GROUP 2 (INJECTABLE AGENTS) KANAMYCIN GROUP 3 (FLUOROQUINOLONES) LEVOFLOXACIN GROUP 4 (ORAL BACTERIOSTATIC AGENTS) ETHIONAMIDE GROUP 5 (AGENTS WITH UNCLEAR EFFICACY) LINAZOLID, AMX-CLV

ANTI-TB DRUGS USED IN RNTCP:

ANTI-TB DRUGS USED IN RNTCP FIRST LINE DRUGS: INH (H) RIFAMPICIN (R) PYRAZINAMIDE (Z) ETHAMBUTOL (E) STREPTOMYCIN (S) SECOND LINE DRUGS: AMIKACIN, KANAMYCIN, FLUOROQUINOLONES, CAPREOMYCIN , ETHIONAMIDE PAS, CYCLOSERINE, etc…

Treatment categories in RNTCP:

Treatment categories in RNTCP

Categorization is based on:

Categorization is based on History of patient, including history of any previous treatment for TB Sputum smear examination results from an approved DMC Chest X-ray report if the case warrants radiographic examination Other supporting investigation reports, if any

FACTORS TO BE MENTIONED IN RNTCP CARD:

FACTORS TO BE MENTIONED IN RNTCP CARD Disease classification (PTB / EPTB) Type of case (NEW / TREATED) Sputum smear result smear + / smear -- Severity of illness History of previous treatment

FACTORS TO BE MENTIONED IN RNTCP CARD:

FACTORS TO BE MENTIONED IN RNTCP CARD Details of X-ray Chemoprophylaxis for contacts aged ≤ 6 years HIV related data Treatment outcome with date Remarks

Slide 16:

CATEGORY I CATEGORY II CATEGORY III CATEGORY IV CATEGORY V DOTS DOTS PLUS

Slide 17:

NEW -> CATEGORY I -> CATEGORY III PREVIOUSLY TREATED -> CATEGORY II CATEGORY IV CATEGORY V DOTS DOTS PLUS

WHAT IS DOTS ?:

WHAT IS DOTS ? D IRECTLY O BSERVED T REATMENT S TRATEGY SHORT COURSE CHEMOTHERAPY INTERMITTENT REGIMEN INCLUDES 1. NEW 2. PREVIOUSLY TREATED

WHAT IS DOTS plus ?:

WHAT IS DOTS plus ? IN RNTCP TO ADDRESS THE MDR TB DIAGNOSIS AND MANAGEMENT DAILY DOT EXCEPT SUNDAY INCLUDES 1. CATEGORY IV 2. CATEGORY V

WHAT IS NON DOTS ?:

WHAT IS NON DOTS ? RARE TB PATIENTS MAY NEED NON RIFAMPICIN AND NON PYRAZINAMIDE REGIMEN DAILY REGIMEN NOT OBSERVED 2 SHE + 10 HE

NEW (CATEGORY I & III):

NEW ( CATEGORY I & III) SMEAR POSITIVE SMEAR NEGATIVE EXTRAPULMONARY OTHERS Treatment :- 2(HRZE) 3 + 4(HR) 3 DURATION 6 MONTHS

PREVIOUSLY TREATED (CATEGORY II):

PREVIOUSLY TREATED (CATEGORY II) RELAPSE SMEAR POSITIVE FAILURE SMEAR POSITIVE DEFAULT SMEAR POSITIVE OTHERS 2(HRZES) 3  1 (HRZE) 3  5 (HRE) 3 Duration- 8 MONTHS

Drugs Dose (thrice a week) :

Drugs Dose (thrice a week ) Isoniazid (H ) 600mg Rifampicin (R ) 450mg P yrazinamide (Z) 1500mg Ethambutol (E ) 1200mg Streptomycin (S ) 0.75g

PEDIATRIC DOSAGE in DOTS:

PEDIATRIC DOSAGE in DOTS Isoniazid (H) – 10 mg/kg ( 10–15 mg/kg) Rifampicin ( R) – 15 mg/kg ( 10–20 mg/kg) pyrazinamide (Z ) – 35 mg/kg (30–40 mg/kg ) ethambutol (E) – 20 mg/kg (15–25 mg/kg) Streptomycin (S) – 15 mg/kg

Follow-up schedule for sputum examination :

Follow-up schedule for sputum examination At the end of the intensive phase , the extended intensive phase (if applicable ), Two months into the continuation phase and At the end of treatment . NEW PATIENT 0, 2, 4, 6 MONTHS PREVIOUSLY 0, 3, 5, 8 MONTHS TREATED

OUTCOME IN DOTS:

OUTCOME IN DOTS CURED TREATMENT COMPLETED DEFAULTED DIED TRANSFERRED OUT FAILURE SWITCHED TO DOTSPLUS

Slide 27:

MDR-TB

MULTIDRUG RESISTANT TB(MDR-TB):

MULTIDRUG RESISTANT TB(MDR-TB) MDR TB SUSPECT: NSP WHO REMAINS SMEAR+ @ 5 MONTHS OF R X NSN WHO BECOMES SMEAR + @ 5 MONTHS OF R X PREVIOUSLY TREATED, SMEAR + ON 4 TH MONTH CLOSE CONTACTS OF MDRTB PATIENTS WITH PTB+ MDR TB PATIENT: AN MDR TB SUSPECT WHOSE SPUTUM IS CULTURE POSITIVE FOR MTB THAT ARE IN VITRO RESISTANT TO H & R WITH OR WITHOUT RESISTANT TO OTHER DRUGS FROM AN RNTCP ACCREDITED LABORATORY.

EXTENSIVELY DR TB (XDR TB):

EXTENSIVELY DR TB (XDR TB) IN VITRO RESISTANCE TO H, R , ANY OF SECOND LINE INJECTABLE AMINOGLYCOSIDES AND ANY ONE OF FLUOROQUINOLONES. NO STANDARD REGIMEN AVAILABLE SHOULD BE TREATED ACCORDING TO CULTURE REPORTS

EXTREME DR TB / TOTAL DR TB (XXDR TB / TDRTB):

EXTREME DR TB / TOTAL DR TB (XXDR TB / TDRTB) RESISTANT TO ALL   first- and second-line drugs TILL NOW NO TREATMENT AVAILABLE (possible)

CATEGORY IV (DOTS PLUS):

CATEGORY IV (DOTS PLUS) MULTI DRUG RESISTANT TB (MDR TB) RIFAMPICIN MONORESITANCE REGIMEN 6(9) Km Lvx Eto Cs Z E FOLLOWED BY 18 Lvx Eto Cs E DURATION 24 – 27 MONTHS

CATEGORY V (DOTS PLUS):

CATEGORY V (DOTS PLUS) EXTENSIVELY DRUG RESISTANT TB (XDR TB) REGIMEN 6(12) INTENSIVE PHASE FOLLOWED BY 18 CONTINUATION PHASE (Cm, PAS, M fx , C fz , L zd , A mx /clv, C lr , T hz ) DURATION 24 -- 30 MONTHS

SUMMARY:

SUMMARY

SUMMARY DIAGNOSIS OF PTB:

SUMMARY DIAGNOSIS OF PTB DURATION OF COUGH 3 WEEKS  2 WEEKS NUMBER OF SPUTUM SMEARS TO BE COLLECTED 3 SMEARS  2 SMEARS NUMBER OF + SMEARS REQUIRED FOR DX OF PTB+ 2 SMEARS  1 SMEAR

SUMMARY TREATMENT OF PTB:

CATEGORY III HAS BEEN PHASED OUT NEW (DOTS) PREVIOUSLY TREATED (DOTS) CATEGORY IV FOR MDRTB CATEGORY V FOR XDRTB SUMMARY TREATMENT OF PTB