Basic TB Treatment Regimens * EMB can be discontinued if drug susceptibility studies demonstrate susceptibility to first-line drugs. ** Guidelines allow dosing 5 or 7 days-a-week; 5 days-a-week administration by DOT is an acceptable alternative to 7 days a-week administration.
How often should I take the TB drugs?
Dec 21, 2016 · Default is defined as tuberculosis treatment interruption of ≥ 30 days after the predicted date of return (self-administered treatment) or of 30 days after the last drug intake (DOT; for management of treatment interruptions, see Chart 4 ). A death from tuberculosis is defined as a death caused by tuberculosis and occurring during treatment.
What is dot for TB treatment?
If anti-TB drugs for the treatment of MDR TB need to be given twice daily, then DOT should be provided twice daily as well. Nearly all the treatment regimens for drug-susceptible TB disease
How long does it take to treat tuberculosis (TB)?
Jan 24, 2020 · National TB treatment guidelines strongly recommend using a patient-centered case management approach - including directly observed therapy ("DOT") - when treating persons with active TB disease. DOT is especially critical for patients with drug-resistant TB, HIV-infected patients, and those on intermittent treatment regimens (i.e., 2 or 3 times weekly).
What is the success rate of dot for tuberculosis (TB)?
TB blood tests are the recommended TB test for: People who have received the bacille Calmette–Guérin (BCG) TB vaccine. ... (DOT), especially treatment for TB disease. If you get DOT, you will meet with a health care worker every day or several times a week. You will meet at a place you both agree on, or by electronic methods.
How many days TB treatment takes?
You'll be prescribed at least a 6-month course of a combination of antibiotics if you're diagnosed with active pulmonary TB, where your lungs are affected and you have symptoms. The usual treatment is: 2 antibiotics (isoniazid and rifampicin) for 6 months.
What is DOTS in TB treatment?
What is DOT? DOT means that a trained health care worker or other designated individual (excluding a family member) provides the prescribed TB drugs and watches the patient swallow every dose.
How long is DOTS for TB?
DOT should be used when drugs are administered less than 7 days per week. Based on expert opinion, patients with cavitation on initial chest radiograph and positive cultures at completion of 2 months of therapy should receive a 7-month (31-week) continuation phase.
How do you know if TB treatment is working?
Physical Signs That TB Treatment Is Working A reduction in symptoms, such as less coughing. Overall improvement in the way one feels. Weight gain. Increased appetite.Dec 16, 2009
When should sputum be collected for TB?
Sputum specimens for microscopic examination and culture should be obtained from patients diagnosed with TB disease at a minimum of monthly intervals until two consecutive specimens are negative on culture. It is critical to obtain a sputum specimen at the end of the intensive phase (2 months) to determine if the continuation phase should be extended. In addition, it is essential that patients have clinical evaluations at least monthly to identify possible adverse effects of the anti-TB medications and to assess adherence. All patients with TB disease should have counseling and testing for HIV.
What is a DOT in TB?
DOT is a strategy in which a health care worker or another designated person watches the TB patient swallow each dose of the anti-TB drugs. All patients taking drugs fewer than 7 days per week (e.g., 1, 2, 3, or 5 days a week) must receive DOT.
How is treatment completion determined?
Treatment completion is determined by the number of doses ingested over a given period of time. Although basic TB regimens are broadly applicable, there are modifications that should be made under special circumstances (i.e., HIV infection, drug resistance, pregnancy, or treatment of children).
What is the first line of anti-TB drugs?
Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens are: isoniazid (INH), rifampin (RIF), ethambutol (EMB), and. pyrazinamide (PZA). Regimens for treating TB disease have an intensive phase of 2 months, followed by a continuation phase of either 4 or 7 months. The continuation phase should be extended ...
Is TB a public health function?
Treating tuberculosis (TB) disease benefits not only the individual patient but the community as a whole.Thus, any health care provider undertaking treatment of a patient with TB, whether a public health or private practitioner, is assuming a public health function that includes the responsibility for not only prescribing an appropriate regimen but also ensuring the patient’s adherence to the regimen until treatment is completed.
How long does it take to treat TB?
As a general rule, the principles used for the treatment of pulmonary TB disease also apply to extrapulmonary forms of the disease. A 6-month treatment regimen is recommended for patients with extrapulmonary TB disease, unless the organisms are known or strongly suspected to be resistant to the first-line drugs. If PZA cannot be used in the initial phase, the continuation phase must be increased to 7 months. The exception to these recommendations is central nervous system TB, for which the optimal length of therapy has not been established but some experts recommend 9 to 12 months. Most experts do recommend corticosteroids to be used as additional therapy for patients with TB meningitis and pericarditis. Consultation with a TB expert is recommended.
How long does it take to develop a TB control plan?
For each patient with newly diagnosed TB disease, a specific treatment and monitoring plan should be developed in collaboration with the local TB control program within 1 week of the presumptive diagnosis. This plan should include:
What are the four drugs that are included in the initial treatment regimen?
Four drugs— INH, RIF, PZA, and EMB — should be included in the initial treatment regimen until the results of drug-susceptibility tests are available. Each of the drugs in the initial regimen plays an important role. INH and RIF allow for short-course regimens with high cure rates. PZA has potent sterilizing activity, which allows further shortening of the regimen from 9 to 6 months. EMB helps to prevent the emergence of RIF resistance when primary INH resistance is present. If drug-susceptibility test results are known and the organisms are fully susceptible, EMB need not be included. For children whose clarity or sharpness of vision cannot be monitored, EMB is usually not recommended except when the risk of drug resistance is high or for children who have “adult-type” (upper lobe infiltration, cavity formation) TB disease.
How long is the TB continuation phase?
The continuation phase of treatment is given for either 4 or 7 months. The 4-month continuation phase should be used in patients with uncomplicated, noncavitary, drug-susceptible TB, if there is documented sputum conversion within the first 2 months. The 7-month continuation phase is recommended only for
What is the recommended treatment regimen based on?
The recommended treatment regimens are based, in large part, on evidence from clinical trials and are rated on the basis of a system developed by the U.S. Public Health Service (USPHS) and the Infectious Diseases Society of America (IDSA) (Table 6.3).
How to educate patients about TB?
Educating patients about TB disease helps ensure their successful completion of therapy. Health-care providers must take the time to explain clearly to patients what medication should be taken, how much, how often, and when. Patients should be clearly informed about possible adverse reactions to the medications they are taking and when to seek necessary medical attention. Providing patients with the knowledge they need regarding the consequences of not taking their medicine correctly is very important. In addition, patients should be educated about infection control measures and potential need for isolation (Table 6.1). HIV testing and counseling is recommended for all patients with TB disease in all health-care settings. The patient must first be notified that testing will be performed. The patient has the right to decline HIV testing and counseling (opt-out screening).
What are the drugs that treat TB?
Food and Drug Administration (FDA) for the treatment of TB disease (Table 6.2). In addition, the fluoroquinolones (levofloxacin, moxifloxacin, and gatifloxacin), although not approved by the FDA for TB disease, are commonly used to treat TB disease caused by drug-resistant organisms or for patients who are intolerant of some first-line drugs. Rifabutin, approved for use in preventing Mycobacterium avium complex disease in patients with HIV infection but not approved for TB disease, is useful for treating TB disease in patients concurrently taking drugs that interact with rifampin (e.g., certain antiretroviral drugs). Amikacin and kanamycin, nearly identical aminoglycoside drugs used in treating patients with TB disease caused by drug-resistant organisms, are not approved by the FDA for treatment of TB.
What should a clinic decide on TB treatment?
Clinicians should choose the appropriate treatment regimen based on drug susceptibility results of the presumed source case (if known), coexisting medical conditions (e.g., HIV. ), and potential for drug-drug interactions. Consultation with a TB expert is advised if the known source of TB infection has drug-resistant TB.
What is the name of the drug that is used to treat TB?
Isoniazid (INH) Rifapentine (RPT) Rifampin (RIF) These medications are used on their own or in combination, as shown in the table below. CDC and the National Tuberculosis Controllers Association (NTCA) preferentially recommend short-course, rifamycin-based, 3- or 4-month latent TB infection treatment regimens over 6- or 9-month isoniazid ...
Is 6H or 9H better for TB?
Although effective, 6H and 9H have higher toxicity risk and lower treatment completion rates than most short-term treatment regimens. All treatment must be modified if the patient is a contact of an individual with drug-resistant TB disease.
When should DOT be initiated?
DOT should be initiated when TB treatment starts. Do not allow the patient to try self-administering medications and missing doses before providing DOT. If the patient views DOT as a punitive measure, there is less chance of successfully completing therapy.
Why do we need a dot?
DOT helps patients finish TB therapy as quickly as possible, without unnecessary gaps. DOT helps prevent TB from spreading to others. DOT decreases the risk of drug-resistance resulting from erratic or incomplete treatment. DOT decreases the chances of treatment failure and relapse.
Who provides DOT?
A nurse or supervised outreach worker from the patient's county public health department normally provides DOT. In some situations, it works best for clinics, home care agencies, correctional facilities, treatment centers, schools, employers, and other facilities to provide DOT, under the guidance of the local health department.
Do home care agencies provide DOT?
DOT providers must remain objective. For complex regimens including IV/IM medications or twice daily dosing, home care agencies may provide DOT or share responsibilities with the local health department . If resources for providing DOT are limited, priority should be given to patients most at risk.
How long does it take for TB to kill?
For TB disease, it takes even longer and at least 6 months for the medicines to kill all the TB germs.
How long does it take to get a second skin test for TB?
You may need a second skin test 8 to 10 weeks after the last time you spent time with the person with TB disease. This is because it can take several weeks after infection for your immune system to react to the TB skin test. If your reaction to the second test is negative, you probably do not have TB infection.
How many people with LTBI will develop TB?
While not everyone with LTBI will develop TB disease, about 5–10% will develop TB disease over their lifetimes if not treated. Progression from untreated LTBI to TB disease is estimated to account for approximately 80% of U.S. TB cases. Some people who have LTBI are more likely to develop TB disease than others.
What does a negative TB test mean?
A negative TB blood test means that your blood did not react to the test and that you likely do not have TB infection. TB blood tests are the recommended TB test for: People who have received the bacille Calmette–Guérin (BCG) TB vaccine.
How to get rid of TB in the air?
Put a fan in your window to blow out (exhaust) air that may be filled with TB germs. If you open other windows in the room, the fan also will pull in fresh air. This will reduce the chances that TB germs will stay in the room and infect someone who breathes the air. Remember, TB is spread through the air.
How does TB spread?
The TB germs are spread into the air when a person with infectious TB disease of the lungs or throat coughs, speaks, or sings. People nearby may breathe in these TB germs and become infected. When a person breathes in TB germs, the TB germs can settle in the lungs and begin to grow.
What is the cause of TB?
Tuberculosis (TB) is caused by bacteria called Mycobacterium tuberculosis (M. tuberculosis). The bacteria, or germ, usually attack the lungs. TB germs can attack any part of the body, such as the kidney, spine, or brain. There is good news. People with TB can be treated if they seek medical help.
How long does TB treatment last?
For new patients with presumed drug susceptible pulmonary TB, the World Health Organisation (WHO) recommends that they should have six months of treatment. This consists of a two month intensive phase followed by a four month continuation phase.
When should a TB smear be performed?
The recommendation from WHO is that for smear positive TB patients treated with first line drugs, the patients should have smear microscopy performed at the end of the two month intensive phase of treatment .
What are the best drugs for TB?
The drugs that a patient should take depends on whether the patient has ever had TB treatment before. If the patient has never had treatment before then it can be assumed that the bacteria in the patient's body will respond, and be sensitive to all the TB drugs. So the patient can then be given the following drugs: 1 Isoniazid 2 Rifampicin 3 Pyyrazinamide 4 & Ethambutol.
Why does TB treatment fail?
It is often suggested that TB treatment fails because a patient doesn’t take their TB drugs correctly. However there can be a number of different reasons for TB treatment failure. It is certainly true that if a patient doesn’t take their TB drugs properly that this can lead to the development of drug resistant TB.
What is the responsibility of a doctor for TB?
A patient must take their drugs properly. But it is also the responsibility of the doctor to make sure that the patient has the correct drugs. The doctor must also explain to the patient how to take the drugs correctly. In many countries there are "alternative" medicines available.
How many drugs are there for TB?
There are more than twenty drugs available for TB treatment. Which ones have to be taken depends on the circumstances of the patient. If you are having TB treatment (sometimes known as antitubercular treatment or ATT), then this should always be supervised by an experienced doctor or other health person.
What happens if you take only one or two TB drugs?
If only one or two TB drugs are taken then only some of the bacteria may be killed. They may then become resistant to the TB drugs which then don't work. If the person becomes sick again then different TB drugs called second line drugs may be needed.
How long do you have to take antibiotics for tuberculosis?
For active tuberculosis, you must take antibiotics for at least six to nine months. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance and where the infection is in your body.
What is the test for TB?
Sputum tests. If your chest X-ray shows signs of tuberculosis, your doctor might take samples of your sputum — the mucus that comes up when you cough. The samples are tested for TB bacteria. Sputum samples can also be used to test for drug-resistant strains of TB.
How long does ethambutol last?
If you have drug-resistant TB, a combination of antibiotics called fluoroquinolones and injectable medications, such as amikacin or capreomycin (Capastat), are generally used for 20 to 30 months. Some types of TB are developing resistance to these medications as well.
What test is used to test for tuberculosis?
The most commonly used diagnostic tool for tuberculosis is a skin test, though blood tests are becoming more commonplace. A small amount of a substance called tuberculin is injected just ...
What to do when you make an appointment?
What you can do. When you make the appointment, ask if there's anything you need to do in advance. Make a list of: Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began.
What to do if you have a positive skin test?
If you've had a positive skin test, your doctor is likely to order a chest X-ray or a CT scan. This might show white spots in your lungs where your immune system has walled off TB bacteria, or it might reveal changes in your lungs caused by active tuberculosis.
Can a TB test be wrong?
Results can be wrong. The TB skin test isn't perfect. Sometimes, it suggests that people have TB when they don't. It can also indicate that people don't have TB when they do. You can have a false-positive result if you've been vaccinated recently with the bacille Calmette-Guerin (BCG) vaccine.
Introduction
Recommended Regimens
- There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens are: 1. isoniazid (INH), 2. rifampin (RIF), 3. ethambutol (EMB), and 4. pyrazinamide (PZA). Regimens for treating TB disease have an intensive phase of 2 months, followed by a continuati…
Hiv-Negative Persons
- A continuation phase of once-weekly INH and rifapentine can be used for HIV-negative patients who do not have cavities on the chest film and who have negative acid-fast bacilli (AFB) smears at the completion of the intensive phase of treatment.
Case Management
- Patient-centered case management should be used in the treatment strategy with an adherence plan that includes directly observed therapy (DOT). DOT is a strategy in which a health care worker or another designated person watches the TB patient swallow each dose of the anti-TB drugs. All patients taking drugs fewer than 7 days per week (e.g., 1, 2, ...
Follow-Up Evaluations
- Sputum specimens for microscopic examination and culture should be obtained from patients diagnosed with TB disease at a minimum of monthly intervals until two consecutive specimens are negative on culture. It is critical to obtain a sputum specimen at the end of the intensive phase (2 months) to determine if the continuation phase should be extended. In addition, it is essential …
For More Information
- Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin I...
- Special Considerations for Treatment of TB Disease in Persons Infected with HIV (Fact Sheet). Available online at https://www.cdc.gov/tb/publications/factsheets/treatment.htm