Tuberculosis Treatment Guidelines

Tuberculosis is an infectious disease caused by a bacillus belonging to a group of bacteria grouped in mycobacterium to tuberculosis complex. Other agents; mycobacterium bovis, mycobacterium africanum. It is transmitted through aerosolized droplet nuclei such as sneezing, coughing or laughing.

Tuberculosis treatment usually involves the patient with TB taking a combination of different TB drugs. In this article, we shall look at the treatment guidelines considering drug combinations for each phase of treatment.

Tuberculosis disease is a state where a person has signs and symptoms of the disease. In this state, there is an active multiplication of the bacilli in the body.

Clinical forms

Tuberculosis occurs in two clinical forms;

1. TB in the lungs known as pulmonary tuberculosis and
2. TB outside the lungs known as extra-pulmonary tuberculosis which affects, lymph nodes, bones, spine, kidneys, liver bladder, skin, eyes, and gastrointestinal tract.

Signs and symptoms

Tuberculosis should be suspected in any person presenting with a cough of more than two weeks duration. The cough may be associated with the production of blood-stained sputum. 
Other symptoms include:

• Night sweats,
• Loss of weight,
• Chest pain,
• Shortness of breath.

Physical signs may include:

• Bronchial breath sounds.
• Tachypnea.
• Haemoptysis.

Basic principles of Tuberculosis treatment

1. Never use single drugs
2. Use drugs in combinations that are, fixed-dose combinations.
3. The drug dosage is based on weight.
4. Drug intake should be directly observed.

In reference to the article here on drugs used in tuberculosis treatment, these are the first line and second-line drugs.

First-line ant-TB drugs.

• Isoniazid (H).
• Rifampicin (R).
• Pyrazinamide (Z).
• Ethambutol (E).
• Streptomycin (S).

Tuberculosis treatment involves the use of multiple drugs taken in combination. This is done to prevent the emergence of drug resistance to any of the drugs.

The treatment regimen for adults

Intensive phase.

During this period the client takes four drugs in two months, this is Rifampicin, Isoniazid, Pyrazinamide, Ethambutol under supervision.

Continuation phase.

During this period two drugs are given for 4 or 6 months, that is,
Rifampicin+Ethambutol- for 6 months.
Rifampicin+ Isoniazid- for 4 months.

The treatment regimen in the summary is 2RHZE/4RH.

The treatment regimen for TB patients who raised failed or returned after default from initial treatment with sputum smear remaining positive at 4/5, 6/8 months, the regimen used is;

Two months of streptomycin, rifampicin, isoniazid, Pyrazinamide, and ethambutol (SRHZE) followed by;
one month of rifampicin, isoniazid, Pyrazinamide, and ethambutol (RHZE) then five months of rifampicin, isoniazid, and ethambutol.

In summary 2SRHZE/1RHZE/5RHE.

The treatment dosage for adults		>55KG	40-55KG	30-39KG
	IM injection	1g	0.75g	0.50g
R-150mg+H-75mg+Z-400mg+E- 275mg	4-FDC tablet RHZE	4	3	2
R-250mg+H-75mg+Z-400mg	3FDC tablet RHZ	4	3	2
R-250mg+ H-75mg	2 FDC tablet RH	4	3	2
R-250mg+ H-75mg+ E-275 mg	Tablet RHE	4	3	2
H-75mg E-275mg	H E	2	2	2

Patients less than 64 years shouldn't be given more than 0.75 mg of streptomycin.

Vitamin B6- pyridoxine supplement is given to clients taking isoniazid so as to prevent peripheral neuropathy. An adult dose is 25 mg.

Children are not routinely given but if their blood levels are low or get a high dose of isoniazid >10 mg/kg then 25 mg supplement is given.