4. TB: A Global Emergency
1/3 of the world (2 billion people) infected
1 person infected/second resulting in >30 million
new infections, 8 million new cases
Left untreated 1/3 die, 1/3 self-cure, 1/3 remain
infectious
TB kills 1 person every 10 seconds = 5000/day
= 2-3 million each year
5. Problem of TB in India
Estimated incidence
1.96 million new cases annually
0.8 million new smear positive cases annually
75 new smear positive PTB cases/1lakh population per year
Estimated prevalence of TB disease
3.8 million bacillary cases in 2000
1.7 million new smear positive cases in 2000
Estimated mortality
330,000 deaths due to TB each year
Over 1000 deaths a day
2 deaths every 3 minutes
6. ANTI- TB DRUGS
FIRST LINE SECOND LINE
ISONIAZID THIOACETAZONE
RIFAMPICIN PAS
PYRAZINAMIDE ETHIONAMIDE
ETHAMBUTOL CYCLOSERINE
STREPTOMYCIN KANAMYCIN
CAPREOMYCIN
AMIKACIN
NEWER DRUGS
CIPROFLOXACIN
OFLOXACIN
CLARITHROMYCIN
AZITHROMYCIN
RIFABUTIN
ISONIAZID
RIFAMPICIN
PYRAZINAMIDE
ETHAMBUTOL
7. WHAT IS DOTS
Directly Observed Therapy Shortcourse is a
program to help cure TB.
A DOT Lay Worker meets with clients to help with
TB medication, and provide support and
education.
DOT by definition means watching clients
swallow each dose of anti-TB medication
8. Directly Observed Treatment Shortcourse
Why? Many patients don’t take medicines regularly, even if excellent
health education provided
Who? All patients... impossible to predict which patient will take medicine
(1/3 not adherent)
What? Observer watches and helps patient swallow tablets
Where? Anywhere! (home, clinic, work, school, etc)
Who does it? HCW, community liaisons, teachers,
Direct observation ensures treatment for entire course with the right drugs,
in the right doses, at the right intervals
9. DIRECT OBSERVED
TREATMENT
SHORTCOURSE(DOTS)
INTENSIVE PHASE
( 2-3 months)
UNDER DIRECT
SUPERVISION OF A
HEALTH WORKER OR
TRAINED PERSON
CONTINUATION PHASE (4-6
months)
A MULTIBLISTER COMBIPACK WITH
DRUGS FOR 1 WEEK IS GIVEN OF
WHICH THE FIRST DOSE IS TAKEN
UNDER SUPERVISION
10. Global Situation
Since 1995,over 21 million patients have been
diagnosed and treated in DOTS programmes
In 2007, 5.5 million new and relapse TB cases
were initiated on treatment under DOTS strategy
Of 2.5 million new smear positive patients
registered in 2006, 85% were successfully treated
under DOTS
11. DOTS Regimen
Category Type of Patient Regimen Duration
in
months
Category I
Color of
box: RED
New Sputum Smear Positive
New Sputum Smear Negative
New Extra Pulmonary
New Others
2 (HRZE)3,
4 (HR)3
6
Category II
Color of
box: BLUE
Sputum Positive relapse
Sputum Positive failure
Sputum Positive treatment
after default
2 HRZES)3,
1 (HRZE)3
5 (HRE)3
8
Test at
month
2
3
H-ISONIAZID R- RIFAMPICIN Z-PYRAZINAMIDE E- Ethambutol
12. Contd.
Category Type of Patient Regimen Durat
ion in
mont
hs
Category III
Color of box:
GREEN
Sputum Negative,
extra pulmonary not Seriously ill
2 (HRZ)3,
4 (HR)3
6
14. MULTI DRUG RESISTANT TB (MDR-TB)
ATLEAST RESISTANT TO ISONIAZID AND RIFAMPICIN
TREATMENT BASED ON DOTS – PLUS
DOTS- PLUS
INTENSIVE PHASE 6-9 MONTHS
KANAMYCIN
OFLOXACIN
CYCLOSERINE
ETHINAMIDE
ETHAMBUTOL
PYRAZINAMIDE
CONTINUATION PHASE 18 MONTHS
OFLOXACIN
CYCLOSERINE
ETHIONAMIDE
ETHAMBUTOL
15. EXTENSIVELY DRUG RESISTANT TB (XDR
TB)
Resistance to Isoniazid and Rifampicin + resistance
to any of the Fluoroquinolones + resistance to any
one of the injectible second line drugs
19. Advantages of DOTS
The client is supported to successfully complete the full
course of medication.
The client is monitored closely for side effects of
medications and supported to work through the side effects
appropriately.
The client is encouraged and supported to complete
required check ups – blood work, chest x-rays, etc.
Reduces the possibility of tb germs becoming resistant to
the medication
