2017 WHO Recommendation for treatment of TB . Things you must know !!!

2017 WHO Recommendation for treatment of TB : Things you must know !!!

1.     Drug and Dosing

a.      The 2017 guideline from WHO strongly suggest the use of RIFAMPICIN based drug regimen ( 2HRZE + 4HR) for 6 months compared to 4 months course with FLUOROQUINOLONE group of drug.

b.     Always use fixed dose combination formulation for treating drug susceptible TB   than individual drug regimen.

c.      The WHO recommends use of DAILY DOSING of drugs compared to THRICE A WEEK regimen in both intensive and continuation phase.

2.      HIV and PTB

a.      ART should be started in all patient living with HIV irrespective of CD4 counts.

b.     TB treatment should be started first followed by ART within 8 weeks (as early as possible). If CD4 cell count is less than 50, it should be started with in 2 weeks.

c.      A 6 months regimen of ATT is enough for patient under ART and 8 months course is not needed.

3.     Steroid

a.      WHO strongly recommends the initial use of steroid (Dexamethasone / Prednisolone) tapered over a period of 6-8 weeks in TB MENINGITIS. While the use of steriod of pericarditis the conditionally recommended.

4.     Retreatment

a.      Category II (2HRZES+1HRZE+5HRE) should no longer be prescribed  

without Drug sensitivity and testing.

Know about various Focuses and Complexes seen in Tuberculosis

The recommendations that still holds valid from 2010 are:

 

1.     Drug and Dosing

a.      New patient with PTB must receive 6 months of ATT therapy (2HRZE + 4HR) that is a Rifampicin based therapy and NOT that contains 2HRZE + 4HE.

b.     The use of daily dosing regimen should be practiced as far as feasible and twice daily dose should never be  used. There were recommendation for use of thrice weekly dose however the newer recommdation strongly favors use of daily dosing regimen.

c.      In areas with high resistance for Isoniazid, the expert recommend the use of HRE in continuation phase rather than HR alone.

d.     The extension of intensive phase is NOT recommended strongly even if the patient is not sputum negative at the end of Intensive phase

2.     TB and HIV

a.      WHO strongly recommends use of Rifampicin based therapy for the patients living with TB and HIV or patient living in high TB prevalent area.

b.     The duration should be NO LESS THAN those with HIV NEGATIVE status that is 6 months.There was suspicion over need of prolonged therapy but the newer recommedation suggests 6 month is sufficient.

c.      The DAILY DOSE THERAPY is recommended.

3.     Re-treatment

a.      The specimen for culture and sensitivity must be obtained in any patient going for re-treatment and sensitivity testing must be done at least for ISONIAZID and RIFAMPICIN.

b.     If possible the therapy should be guided based upon Rapid Molecular susceptibility testing.

For other details and full text follow the link to http://apps.who.int/iris/bitstream/10665/255052/1/9789241550000-eng.pdf?ua=1