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