|
Category of treatment |
Type of patient |
Regimen |
| CATEGORY I | New sputum smear positive | 2(HRZE)3 4(HR)2 |
| Seriously ill smear negative | ||
| Seriously ill extrapulmonry | ||
| Category II | Sputum smear positive positive relapse | 2(HRZES)3/1(HRZE)3/5(HRE)3 |
| Sputum smear positive failure | ||
| Sputum smear positive treatment after default | ||
| Category III | Sputum smear negative not seriously ill | 2(HRZ)3/4(HR)3 |
Categorywise sputum examination results and actions to be taken
| Category of treatment | Pretreatment sputum | Test at month | IF result is: | THEN |
| Category I | + | 2 | - | Start continuation phase,test sputum again at 4 and 6 months |
| + | Continue intensive phase for one more month | |||
| - | 2 | - | Start continuation phase,test sputum again at 6 months | |
| + | Continue intensive phase for one more month,test sputum again at 3,4, and 7 months | |||
| Category II | + | 3 | - | Start continuation phase,test sputum again at 5 and 6 months |
| + | Continue intensive phase for one more month,test sputm again at 4,6 and 9 months | |||
| Category III | - | 2 | - | Start continuation phase,test sputum again 1t 6 months |
| + | Reregister the patient and begin Category II treatment |
The number before the letters (eg 2(HRZE etc) refers to the number of months of treatment.The subscript after the letters refers to the number of doses per week.H:Isoniazid(600mg) Rifmapicin(450mg) Z:Pyrazinamide(1500mg).Patients who weigh more than 60Kg receive additional rifampicin 150 mg.Patients more than 50 years old receive Streptomycin 500mg.Patients in categories I and II who have positive sputum smear at the end of the initial intensive phase receive an additonal month of intensive treatment
Examples of seriously ill extrapulmonary cases are meningitis,disseminated TB,tuberculous pericarditis,peritonitis,,bilateral extensive pleurisy,spinal TB with neurological complications. and intestinal and genitourinary TB.
In rare and exceptional cases patients who are sputum smear negative or who have extrapulmonary disease can have relapse or failure.This diagnosis in all such cases should always be made by an MO and should be supported by culture or histological evidence of current active tuberculosis.In these cases,the patient should be categorized as "Other" and given Category II treatment.
Any patient treated with Category I or Category II who has a positive smear at 5,6, or 7 months of treatment should be considered a failure and started on Category II treatment afresh.
Phases and duration of treatment
Category
Duration(Number of doses)
Total
Intensive phase
Continuation phase
CAT I
8 weeks(24 doses)
18 weeks(54 doses)
26 weeks(78 doses)
CAT II
12 weeks(36 doses)
22 weeks(66 doses)
34 weeks(102 doses)
CAT III
8 weeks(24 doses)
18 weeks(54 doses)
26 weeks(78 doses)
Revised national tuberculosis programme