National protocol for

tuberculosis treatment
 Target patients

2. pt who discharging tubercle bacilli which can

be demonstrated by sputum microscopic
examination i.e smear positive (open case)
3. pt with bacteriologically unconfirmed TB
(Person with suspected TB based on clinical or
X-ray appearance, suffering from extra
pulmonary TB, contact with smear positive pt
 Methods of control
1. BCG vaccine
2. Case finding
3. Treatment of cases
 BCG vaccination
*It is L.A vaccine given by intra dermal injection
*It given to people considered to be non-infected
(children) to protect them from developing TB
specially severe form of the disease.
*Dose 0.05 ml in < 1year, 0.1 ml in >1year
*Complication:
• subcutaneous abscess at site of infection
• Ulceration at the site of injection
• Swelling + ulceration LN adjacent to the
vaccination site
• Systemic complication
 Case finding
• Diagnosis of tuberculosis by identification of TB
bacilli either by smear microscopy or culture
• Smear examination done for suspected TB
cases (even extra pulmonary)
• Clinical examination and Chest X-ray finding
suggestive of TB helpful in smear -ve pts in
pulmonary in small children and miliary cases.
• Mantoux test is helpful in children suspected of
TB who are less 5 years and have not received
BCG vaccination
• Pulmonary TB is present when:
2. There 2 +ve result of sputum
examination
3. In case with –ve smear with highly
suggestive clinical and chest x-ray
finding
4. Children with clinical symptoms and +ve
mantoux (in non-vaccinated children)
 Treatment of tuberculosis
• TB treatment must not be started until a firm
diagnosis has been made
• The recommendation is to adopt a new 8month
regimen with HE in the continuation phase
recategorizing the TB patient into 2 categories of
treatment instead of 3.

CAT-1: includes all new cases ( smear +ve and –

ve ) in addition to extra pulmonary cases.
CAT-2 : includes retreatment cases ( failure,
relapse, return after default).
 CAT-1 treatment
Initial phase Rifampicin
(2 month( Isoniazide
Streptomycin
Pyrazinamide
Continuation phase Ethambutol
(month 6) Isoniazide

*In children <8 years ethambutol replaced by rifampicin in

continuation phase
*in pregnancy do not give streptomycin, ethambutol can be used
* Pt will has –ve smear within first 2 weeks of treatment
(CAT-2 treatment (retreatment
Initial phase Rifampicin
Isoniazide
(2month) Streptomycin
Pyrazinamide
Ethmbutol
Rifampicin
Isonizide
(1month) Pyrazinamide
Ethmbutol
Continuation phase Ethambutol
(month 6) Isoniazide
Rifampicin
 Dosing for anti tuberculosis drugs

Drug Dose/kg Strength/

tab
(Isoniazide (H 5mg 100mg
(Rifampicin(R mg 10 150mg
pyrazinamide 25mg 400mg
Ethambutol Initial 20-25mg
400mg
Continuation 15mg
Streptomycin 15mg Inj 750mg
(Rifina (RH 10/5mg 150/75mg
Common Side effects of anti tuberculosis drug

• INH: neurotoxicity & liver damage.

• Rifampicin: hepatitis, change color of body
secretion to pink
• Strreptomycin: vestibular damage
• Pyrazinamide: hepatitis and artheralgia
• Thiacetazone: anemia, GI upsets
• Ethambutol:decrease in visual acuity,
blirring with red –green color blind ness
 Contacts of smear +ve cases
• Children aged 6 years and over :
>> investigate them for TB if they have symptoms or signs of TB.
• Children under 6 year old:
>> first check tuberculin test
*if not vaccinated &tuberculin +ve =treat fully for TB
*if nt vaccinated &tuberculin –ve= give Rifina for 3 months then
check tuberculin at the end of 3 months.
*if stilll –ve stop Rifina and give BCG vaccination
• A newborn of amother with open TB:
>> infant given INH for 3months then check mantoux test
* if +ve = treat for 6 month in all
* if –ve = stop INH and give BCG vaccination
• Breast feeding should continue
 Defaulters
• All cases default for more than 3 months
are candidate for full treatment.
• Default in initial phase more than 2 weeks
restart treatment
• Default in continuation phase less than 1
month check mantoux
if +ve =restart the treatment
if –ve =contiue the treatment
 Definitions
• Smear positive relapses:
Pt with smear positive pulmonary TB,
previously treated for active TB who
declared cured after completion of a
course of chemotherapy of TB.
• Smear positive failure cases:
Pt who are do not show, or temporarily
show, sputum conversion while receiving
treatment for TB with first-line regimen
• Drug resistance :
2. Naturally : due to bacterial mutations
3. Acquired or secondary : with in corrrect
chemotherapy therapy eg. Treatment
with single potent drug in smear =ve pt.
4. Primary resistance: pt with acquired
resistance infect a healthy individual .