• Management of TBT

• he goal of pulmonary tuberculosis treatment is to cure the patient, prevent

death, prevent recurrence, break the chain of transmission and prevent the
occurrence of germ resistance against OAT (Anti Tuberculosis Drug).The
OAT type consists of Isoniazid (H), Rifampicin (R), Pyazinamide (Z),
Etambutol (E) and Streptomycin (S). TB treatment is given in 2 stages, ie
intensive and advanced stage. In the intensive phase (beginning) the
patient gets the drug every day and needs to be supervised directly to
prevent drug resistance, if the intensive treatment is given properly, usually
infectious patient becomes non-infectious within 2 weeks, most people
with smear positive TB become smear negative (conversion) within 2
months. At an advanced stage the patient gets fewer drugs, but in the
longer term, an advanced stage is necessary to kill the germs of the
persister to prevent recurrence.DOTS
• Strategy DOTS
• (Directly Observed Treatment Shortcourse)
• 1. Political commitment of decision makers including financial support.
• 2. Discovery of the patient with microscopic sputum examination.
• 3. Treatment with a combination of short-term Anti-Tuberculosis (OAT)
drugs with direct supervision by the Drug Swallowing Supervisor (PMO).
• 4. Guarantee the availability of short-term OAT regularly, thoroughly and
on time with guaranteed quality.
• 5. A recording and reporting system capable of providing an assessment
of the patient's treatment outcomes and overall program performance.
According to WHO 2008 guidelines make phasing out MDR TB treatment (World Health
Organization, 2008):
Stage 1: use any first-line drugs that still show efficacy
Stage 2: add the above drug with one class of injectable drug based on the results
sensitivity test and medical history
Stage 3: add the above drugs with one of the fluoroquinolone class drugs
Stage 4: add the above drugs with one or more of the class medications
4 to at least 4 available drugs are available
effective
Step 5: consider adding at least 2 drugs from class 5
(through a consultation process with MDR TB specialists)