Three Times Weekly Anti-tuberculosis Treatment of Category 1 and Category 11 Patients of Pulmonary Tuberculosis Under Directly Observed Therapy (dots)
more cost effective. (3)
Intermittent ATT given three times a week is as efficacious as daily therapy.Isoniazid; Rifampin, Pyrazinamide, and Streptomycin are all efficacious when given three times weekly as when given daily. This finding should not be surprising, because Mycobacterium tuberculosis doubles in 18-24 hours, compared with 12-20 minute for most bacteria(4).
DOTS has been employed with success UN many countries. We conducted this study under DOTS strategy to see the results of three days a week regimens to get better results with less cost.
PATIENTS AND METHODS:
Criteria for enrolling the patients for study:
1. Patients who fulfilled the World Health Organization (WHO)diagnostic criteria for category 1(Patients who have never received treatment for TB) and category 11(Retreatment of ,relapse, treatment failure, smear positive who have taken ATT more than one month and defaulted)pulmonary tuberculosis (WHO) guidelines for national programmed treatment of tuberculosis 2003.
2. Patients and their family promised to come regularly thrice a week for eight months.
130 patients were enrolled for study.70 patients of category 1 and 60 patients of category11.Out of 70 patients of category1, 40 patients (57%) were sputum smear positive and 30 patients (43%) were sputum smear negative.
In category 11 out of 60 patients, 10 patients (17%)were previously treated for 8 months,6 of these patients were sputum smear positive.50 patients had interrupted their treatment after more than one month. In category 11 36 patients (60%) was sputum smearing positive and 24 patients (40%) were sputum smear negative.
Out of the total 130 patients there were 70 male (54%) and 60 females (46%).Their ages ranged from 16-65 years. 80% of the patients were between 20 and 55 years of age.
MANAGMENT:
1. COUNCILLING:
A. The patient and his family were informed about TB disease, its spread, progress and treatment. Regular treatment for 8 months will cure the patient. Irregular treatment or interruption of treatment before 8 months will make the disease resistant to treatment and chances of cure will diminish.
B. Diet: Advised to eat everything available. Diet should increase every day some patients are given drugs to stimulate appetite. Few patients needed short course of corticosteroids.
C. Emphasis was on regular visits and not to miss treatment at all. Patients and their family’s contact numbers and address were noted.
2. Drug Treatment: All the patients were given treatment 3 days a week under DOTS strategy. The drugs were given as separate drugs and doses were calculated according to weight of the patients as recommended by WHO guidelines for treatment of tuberculosis 2003 for 3 days week regimen.
In category 1 during initial phase months Rifamicin, Isoniazid, Pyrazinamide and Ethambutol were given and during continuation phase of six months Rifampcin, Isoniazid, and Ethambutol were given.
In category 11 patients, during initial phase of two months Rifamicin, Isoniazid, Pyrazinamide, Ethambutol and Streptomycin were given. In 3rd months initial phase Streptomycin was stopped and other four drugs were continued. During continuation phase of 5 months Ionized, Rifampin, and Ethambutol were continued
.
3. On every visit:
a. Patient was attended straight away on arrival with greetings and enquired about his health, family and job.
b. Temperature and weight recorded. Patients not gaining weight were advised to increase the diet. Some were given drugs to stimulate appetite and few given corticosteroids.
c. A glass of water and medicine given under supervision
d. Any co-existent illness was also treated.
e. On leaving, patient was reminded about the next visit. If he cannot come then medicine were given to his family member to give the patient under his supervision. The patient was made to feel that we care for him and want him to get better.
PROGRESS: X-RAY CHEST, ESR,Hb, and soutum smear for A.F.B were repeated at 2 months, 5 months and end of treatment at 8 months.
RESULT:
After completion of eight months of ATT, the following criteria were taken for cure.