Treatment of recently sputum positive case of pulmonary TB is
Ans. c (RMP + INH + PZM + ETM); (Ref. Park PSM 22nd/pg. 175)Treatment categories and sputum examination schedule in DOTS chemotherapy in IndiaTREATMENT REGIMENSPUTUM EXAMINATIONS FOR PULMONARY TBCategory of treatmentType of patientRegimenPret- reat- ment sputumTest at monthIF: result is-----THEN:New cases Category I Red BoxNew sputum smear-positiveNew sputum smear-negativeNew extra-pulmonary**New others2(HRZEE)3+4(HR)3+2-Start continuation phase, test sputum again at 4 and 6 months +Continue intensive phase for one more monthComplete the treatment in 7 monthsPreviouslyTreatedCategory IIBlue BoxSputum smear positiveRelapse***Sputum smear-positiveFailure***Sputum smear-positive treatment after default others2(HRZES)3+1(HRZE)3+5(HRE)3+3-Start continuation phase, test sputum again at 5 months 6 months, completion of treatment + + Continue intensive phase for one more month, test sputum again at 4 months if sputum is positive send sputum for culture and drug sensitivity as it might be a case of MDR-TB* The number before the laetters refers to the number of months of treatment. The subcript after the letters refers to the number of doses per week. H; Isoniazid (600 mg), R: Rifampi (450 mg), Z: pyrazinamide (1500 mg), E: Ethambutol (1200 mg), S: Streptomycin (750 mg).Patients who weigh more than 60 kg receilve additional Rifampicin 150 mg. Patients more than 50 years old receive streptomycin 500 mg.Patients in categories I and II, who have a positive sputum smear at the end of the initial intensive phase, receive an additional month of intensive phase treatment.** Examples of seriously ill extra-pulmonary TB cases are meningitis, disseminated TB, tuberculous pericarditis, peritonitis, bilateral or extensive pleurisy, spinal TB with neurological complications and intestinal and genito-urinary TB.*** In rare and exceptional cases, patients who are sputum smear-negative or who have extra-pulmonary 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 who has a positsive smear at 5 months of treatment should be considered a failure and started onCategory II treatment, afresh. If category I sputum smear-ve case fails to improve or if patient develops pulmonary signs and positive smear at the end of intensive phase, it is considered treatment failure. Start category II treatment and confirm failure by culture and perform DST.
RMP + INH + PZM
RMP + INH + PZM + SMC
RMP + INH + PZM + ETM
RMP + INH + ETM
Communicable Diseases