It is thus essential that re-treatment TB
Tuberculosis
A contagious infection caused by bacteria that mainly affects the lungs but also can affect any other organ.
Full Answer
When is DST indicated in the treatment of tuberculosis (TB)?
Some programmes recommend DST for HIV-infected TB patients with CD4 counts below 200 cells/mm3(6). • Persons who develop active TB after known exposure to a patient with document- ed MDR-TB. • All new patients in countries where the level of MDR-TB in new patients is >3% (23). 44 TrEaTmEnT of TubErCuloSIS: GuIdElInES
What is community-based care for tuberculosis (TB)?
In community-based care, a TB treatment supporter shares with the TB patient re- sponsibility for the successful completion of treatment; he or she provides therapy under supervision as well as social and psychological support (8).
What are the who consolidated guidelines on tuberculosis (TB)?
In March 2021, WHO released the WHO consolidated guidelines on tuberculosis. Module 2: Screening – systematic screening for tuberculosis disease (1). These guidelines include 17 new and updated recommendations for the screening of TB disease.
What is the initial treatment for tuberculosis (TB) (TB)?
For TB patients, CPT should be initiated as soon as possible, irrespective of the CD4 cell count, and given throughout anti-TB treatment; continuation after treatment is completed should be considered in accordance with national guidelines.
What is the WHO recommended treatment protocol for TB?
For treatment of new cases of pulmonary or extrapulmonary TB, WHO recommends a standardized regimen consisting of two phases. The initial (intensive) phase uses four drugs (rifampicin, isoniazid, pyrazinamide and ethambutol) administered for two months.
WHO TB treatment categories?
WHAT IS THE TREATMENT FOR TUBERCULOSIS? Tuberculosis can be cured. Directly Observed Treatment, Short- course (DOTS) is the most effective way to ensure cure. There are three categories of treatment: Categories I, II and III and each has an Intensive Phase and Continuation Phase.
Why is TB a multi drug therapy?
Multidrug-resistant TB (MDR TB) is caused by TB bacteria that are resistant to at least isoniazid and rifampin, the two most potent TB drugs. These drugs are used to treat all persons with TB disease.
What are the 4 first-line drugs for the treatment of TB?
Of the approved drugs, isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA) are considered first-line anti-TB drugs and form the core of standard treatment regimens (Figure 6.4) (Table 6.2). Rifabutin (RBT) and rifapentine (RPT) may also be considered first- line drugs under certain circumstances.
What is Category 1 treatment?
1. A pouch containing drugs for a Treatment Category 1 patient. Category 1 was for new smear positive patients with pulmonary TB. Category 2 was for sputum smear positive patients who have relapsed, who have treatment failure or who are receiving treatment after treatment interruption.
What are the 3 types of tuberculosis?
Tuberculosis is a bacterial infection that usually infects the lungs. It may also affect the kidneys, spine, and brain. Being infected with the TB bacterium is not the same as having active tuberculosis disease. There are 3 stages of TB—exposure, latent, and active disease.
What is MDR and XDR-TB?
Extensively drug-resistant TB (XDR TB) is a rare type of multidrug-resistant tuberculosis (MDR TB) that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin).
What is DOTS program?
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.
What is DST test for TB?
Drug susceptibility testing (DST) of Mycobacterium tuberculosis is generally carried out after a culture is isolated from a clinical specimen. This takes a long time, first to isolate a culture and then to perform drug susceptibility testing (indirect DST).
What are 3 drugs for TB?
Rifampin (RIF),Isoniazid (INH),Pyrazinamide (PZA), and.Ethambutol (EMB)
Why is isoniazid and rifampin given together?
Isoniazid and rifampin are antibiotics that fight bacteria. Isoniazid and rifampin is a combination medicine used to treat tuberculosis (TB). Isoniazid and rifampin may also be used for purposes not listed in this medication guide.
What is the difference between first-line and second-line TB drugs?
The first-line therapeutic drugs are the most effective and least toxic for use in the treatment of TB, while the second-line therapeutic drugs are less effective, more expensive and have higher toxicities. They are however, essential for the treatment of drug resistant forms of the bacteria (MDR-TB).
What is MDR TB?
Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to isoniazid and rifampicin, the 2 most effective first-line anti-TB drugs. MDR-TB is treatable and curable by using second-line drugs.
When was the first high level meeting on TB?
On 26 September 2018 , the United Nations (UN) held its first- ever high-level meeting on TB, elevating discussion about the status of the TB epidemic and how to end it to the level of heads of state and government. It followed the first global ministerial conference on TB hosted by WHO and the Russian government in November 2017. The outcome was a political declaration agreed by all UN Member States, in which existing commitments to the SDGs and WHO’s End TB Strategy were reaffirmed, and new ones added.
What percentage of TB cases fall short of what is needed?
Investments in TB prevention, diagnosis and care for tuberculosis in low- and middle-income countries (LMICs) accounting for 98% of reported TB cases, fall far short of what is needed. Less than half (41%) of the global TB funding target is available, leaving a US$ 7.7 funding gap in 2020 to achieve global targets.
What are the symptoms of TB in the lung?
Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats. WHO recommends the use of rapid molecular diagnostic tests as the initial diagnostic test in all persons with signs and symptoms of TB as they have high diagnostic accuracy and will lead to major improvements in the early detection of TB and drug-resistant TB. Rapid tests recommended by WHO are the Xpert MTB/RIF, Xpert Ultra and Truenat assays.
How many lives have been saved from TB?
An estimated 60 million lives were saved through TB diagnosis and treatment between 2000 and 2019. Ending the TB epidemic by 2030 is among the health targets of the United Nations Sustainable Development Goals (SDGs). Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs.
How much is TB funding in 2020?
Spending in 2020 amounted to US$ 5.3 billion less than half (41%) of the global target.
How many people died from TB in 2019?
Key facts. A total of 1.4 million people died from TB in 2019 (including 208 000 people with HIV). Worldwide, TB is one of the top 10 causes of death and the leading cause from a single infectious agent (above HIV/AIDS).
When will the WHO consolidated guidelines on tuberculosis be released?
In July 2021, WHO released the WHO consolidated guidelines on tuberculosis. Module 3: Diagnosis – rapid diagnostics for tuberculosis detection 2021 update (3). Three new classes of nucleic acid amplification test (NAAT) are now endorsed by WHO:
What are the challenges of TB in refugees?
Refugees and other displaced populations in humanitarian emergencies face significant threats to health and survival, including poverty, crowded living conditions, undernutrition and poor access to health care. These conditions predispose people to an increased risk of TB infection and development of disease. WHO, in collaboration with the United Nations (UN) High Commissioner for Refugees (UNHCR) and the United States Centers for Disease Control and Prevention (US CDC), will shortly release a field guide to address the challenge of TB in refugees. This guide will include new strategic approaches, guidance and innovations on TB prevention and care interventions in humanitarian crisis situations, to prevent and alleviate the suffering and deaths caused by TB among refugees and displaced populations. Its relevance is underlined by the continued large-scale population movements worldwide induced by conflict, poverty, natural disasters and a changing climate.
What is TB diagnostic category IV?
Patients in whom drug-resi stant TB is diagnosed and who require treatment with second-line drugs are classified as WHO TB diagnostic Category IV and require regimens termed “Category IV regimens”. This section provides guidance on the strategy options, including standardized, empirical and individualized approaches, for treating drug-resistant TB. A description of drugs, doses and coding of treatment regimens is provided in Guidelines for the programmatic management of drug-resistant tuberculosis.
What is the first line of anti-TB medication?
The standardized regimens for anti-TB treatment recommended by WHO include five essential medicines designated as “first line”: is oniazid (H), rifampicin (R), pyrazinamide (Z), ethambutol (E) and streptomycin (S). Table 2.1 shows the recommended doses for adults and children.
What are the first line antibiotics for TB?
The standardized regimens for anti-TB treatment recommended by WHO include five essential medicines designated as “first line”: isoniazid (H), rifampicin (R), pyrazinamide (Z), ethambutol (E) and streptomycin (S). Table 2.1shows the recommended doses for adults and children.
How long does TB treatment last?
For treatment of new cases of pulmonary or extrapulmonary TB, WHO recommends a standardized regimen consisting of two phases. The initial (intensive) phase uses four drugs (rifampicin, isoniazid, pyrazinamide and ethambutol) administered for two months. This is followed by a continuation phase with two drugs (rifampicin and isoniazid) for four months or, exceptionally, with two drugs (isoniazid and ethambutol) for six months when adherence to treatment with rifampicin cannot be ensured (Table 2.2).
When designing a regimen, should you take into consideration the drug resistance?
Drugs commonly used in the country and prevalence of resistance to first-line and second-line drugs should be taken into consideration when designing a regimen.
Can drug resistance develop in previously treated patients?
Drug resistance is more likely to develop in previously treated patients (i.e. patients who have been treated for longer than one month) who continued to be or who became sputum smear (or culture) positive. Ideally, all previously treated patients should be assessed for drug susceptibility before initiating chemotherapy. However, in settings where access to quality-assured culture and DST is limited, WHO recommends a standardized regimen for previously treated cases. Table 2.3shows the possible therapeutic options for previously treated patients (Category II regimen).
How many questions are there in WHO TB?
The recommendations that address each of the seven questions are listed below, and also appear in bold text in Chapter 3 (Standard treatment regimens), Chapter 4 (Monitoring during treatment) and Chapter 5 (Co-management of HIV and active TB). Areas outside the scope of the seven questions, as well as the remaining chapters, have been updated with current WHO TB policies and recent references but were not the subject of systematic literature reviews or of new recommendations by the Guidelines Group.
When to get sputum for mi-croscopy?
Remark: National TB control programmes (NTPs) should continue to follow the current WHO recommendation to obtain sputum specimens for smear mi- croscopy at the end of months 5 and 6 for all new pulmonary TB patients who were smear-positive at the start of treatment. Patients whose sputum smears are positive at month 5 or 6 (or who are found to harbour MDR-TB strains at any
Does intensive phase help with TB?
Remark b: Daily (rather than three times weekly) intensive-phase dosing may also help prevent acquired drug resistance in TB patients starting treatment with iso- niazid resistance. The systematic review (Annex 2) found that patients with isoni- azid resistance treated with a three times weekly intensive phase had significantly higher risks of failure and acquired drug resistance than those treated with daily dosing during the intensive phase.
Can TB patients with HIV be treated with HIV?
It is recommended that TB patients who are living with HIV should receive at least the same duration of TB treatment as HIV-negative TB patients (Strong/High grade of evidence)
Further reading
WHO consolidated guideline on drug-resistant tuberculosis treatment. (WHO/CDS/TB/2019.4). Geneva, World Health Organization, 2019
Acknowledgement
We would like to thank the colleagues from the Global Fund to Fight AIDS, Tuberculosis and Malaria, United States Agency for International Development and the Global Drug Facility of the Stop TB Partnership for their comments and contribution to the FAQs.
When was MDR/RR-TB issued?
treatment of multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) issued since 2011 (2–6)(as well as recommendations in other
What is the CDC?
CDC (United States) Centers for Disease Control and Prevention
Who Is Most at Risk?
Global Impact of TB
- TB occurs in every part of the world. In 2020, the largest number of new TB cases occurred in the WHO South-East Asian Region, with 43% of new cases, followed by the WHO African Region, with 25% of new cases and the WHO Western Pacific with 18%. In 2020, 86% of new TB cases occurred in the 30 high TB burden countries. Eight countries accounted for two thirds of the new TB case…
Symptoms and Diagnosis
- Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats. WHO recommends the use of rapid molecular diagnostic tests as the initial diagnostic test in all persons with signs and symptoms of TB as they have high diagnostic accuracy and will lead to major improvements in the early detection of TB …
Treatment
- TB is a treatable and curable disease. Active, drug-susceptible TB disease is treated with a standard 6-month course of 4 antimicrobial drugs that are provided with information and support to the patient by a health worker or trained volunteer. Without such support, treatment adherence is more difficult. Since 2000, an estimated 66 million lives we...
TB and HIV
- People living with HIV are 18 (Uncertainty interval: 15-21) times more likely to develop active TB disease than people without HIV. HIV and TB form a lethal combination, each speeding the other's progress. In 2020, about 215 000 people died of HIV-associated TB. The percentage of notified TB patients who had a documented HIV test result in 2020 was only 73%, up from 70% in 2019. In th…
Multidrug-Resistant TB
- Anti-TB medicines have been used for decades and strains that are resistant to one or more of the medicines have been documented in every country surveyed. Drug resistance emerges when anti-TB medicines are used inappropriately, through incorrect prescription by health care providers, poor quality drugs, and patients stopping treatment prematurely. Multidrug-resistant tuberculosi…
Catastrophic Cost
- WHO’s End TB Strategy target of “No TB patients and their households facing catastrophic costs as a result of TB disease”, monitored by countries and WHO since WHA67.1 End TB Strategy was adopted in 2015, shows that the world did not reach the milestone of 0% by 2020. According to the results of 23 national surveys on costs faced by TB patients and their families, the percentag…
Investments in TB Prevention, Diagnosis and Treatment and Research
- US$ 13 billion are needed annually for TB prevention, diagnosis, treatment and care to achieve global targets agreed on UN high level-TB meeting. 1. Investments in TB prevention, diagnosis and care for tuberculosis in low- and middle-income countries (LMICs) accounting for 98% of reported TB cases, fall far short of what is needed. Less than half (41%) of the global TB funding target is …
Global Commitments and The Who Response
- On 26 September 2018, the United Nations (UN) held its first- ever high-level meeting on TB, elevating discussion about the status of the TB epidemic and how to end it to the level of heads of state and government. It followed the first global ministerial conference on TB hosted by WHO and the Russian government in November 2017. The outcome was a political declaration agree…
Screening
- In March 2021, WHO released the WHO consolidated guidelines on tuberculosis. Module 2: Screening – systematic screening for tuberculosis disease (1). These guidelines include 17 new and updated recommendations for the screening of TB disease. Populations identified as priorities for TB screening include contacts of TB patients, people living with HIV, people expose…
Diagnosis
- In July 2021, WHO released the WHO consolidated guidelines on tuberculosis. Module 3: Diagnosis – rapid diagnostics for tuberculosis detection 2021 update (3).Three new classes of nucleic acid amplification test (NAAT) are now endorsed by WHO: 1. moderate complexity automated NAATs, which are recommended for the initial detection of TB and resistan...
Treatment
- In April 2021, WHO convened a guideline development group (GDG) to review data from a trial conducted in 13 countries that compared 4-month rifapentine-based regimens with a standard 6-month regimen in people with drug-susceptible TB (6). The GDG considereda 4-month regimen composed of rifapentine, isoniazid, pyrazinamide and moxifloxacin that met the non-inferiority c…
Comorbidities, Vulnerable Populations and People-Centred Care
- In May to June 2021, WHO convened a GDG to review updated evidence on the management of TB in children and adolescents (aged 0–9 and 10–19 years, respectively). A rapid communication thatsummarizes the main updates to guidance on the management of TB in children and adolescents was released by WHO in August 2021 (8). The communication includes new inform…
Other Actions to Support TB Policy Guidance
- To exchange views on emerging areas where there is a need for global TB policy guidance, in March 2021, WHO convened a consultation on the translation of TB research into global policy guidelines, attended by scientists, public health experts, partners,civil society and countries (9). In June 2021, WHO launched a TB Knowledge Sharing Platform to bring all WHO TB guidelines, op…