Treatment of Pulmonary Tuberculosis: What Every GP Should Know

Authors: Lancelot M. Pinto, MD, MSc—Author; Madhukar Pai, MD, PhD—co-author and Series Editor
Number of pages: 4
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Overview: Nearly 50% of patients with TB in India are treated in the private sector. GPs therefore share the responsibility of TB control in India, and play a major role in preventing the spread of the disease by curing patients and arresting transmission. Every GP will need to consider TB as a differential diagnosis in persons with cough lasting two weeks or more, or with abnormal findings on chest radiography. In such patients, TB must first be microbiologically confirmed, either using sputum smear microscopy, Xpert MTB/RIF (i.e., GeneXpert), or liquid cultures. Once TB is confirmed, the next step is to begin the correct anti-tuberculosis therapy (ATT) regimen, as recommended by Standards for TB Care in India (STCI) and the International Standards for TB Care (ISTC). All patients who have not been treated previously and do not have other risk factors for drug resistance should receive a WHO-approved first-line treatment regimen for a total of 6 months. The initial phase should consist of two months of isoniazid, rifampicin, pyrazinamide and ethambutol. The continuation phase should consist of isoniazid and rifampicin given for 4 months (ethambutol can also be added to the continuation phase in areas with high levels of isoniazid resistance). Treatment can be given daily or as thrice-weekly intermittent dosing. Adherence to the full course of ATT is very important to ensure high cure rates and to prevent the emergence of drug-resistance. If patients have any risk factors for drug-resistance, or do not respond to standard ATT, they must be investigated for MDR-TB using drug-susceptibility tests (DST) like GeneXpert, line probe assays, and liquid cultures. MDR-TB requires long-term and specialized treatment. So, patients should be referred to chest specialists, either in the private sector, or in the public sector where free MDR treatment is available.

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Treatment of Pulmonary Tuberculosis: What Every GP Should Know

2 thoughts on “Treatment of Pulmonary Tuberculosis: What Every GP Should Know

  1. I still not adherent to the intermittent treatment.
    How i wish we put more money at community levels to have treatment supporters (TS)/ care givers (CG) to ascertain patients drugs consumption and have the DOTs implemented fully?
    Are we then happy with poor cure rate? or do we even cure TB with growing relapses? Do we really finish the TB allocated budget to not do much with such TB pandemic described in India and else where.
    I am an implementor and a mentor for those type of strategies …!!!

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