General Management of Tuberculosis

exp date isn't null, but text field is

Tuberculosis  is  chronic  airborne  infectious  disease  caused  by  Mycobacterium  tuberculosis.  It  is  transmitted from one person to another when a patient is coughing, sneezing or singing. 

Clinical presentation 

  • Cough of more than two weeks or of any duration in among PLHIV 
  • Fever 
  • Excessive night sweats 
  • Haemoptysis (sputum mixed with blood stains) 
  • Loss of weight 
  • Others  includes  swelling  of  lymph  nodes,  ascites,  difficulty  in  breathing,  chest  pain, swelling of joints etc., depending on the site of the disease 

Investigations 

  • Sputum - smears microscopy or sputum for rapid molecular tests like Gene–Expert 
  • Culture and sensitivity; this is done for diagnosis of drug resistance and surveillance 
  • Chest X-rays: done to assist clinical diagnosis of TB or in case of triaging presumptive 

Note: 

  • Conduct HIV provider-initiated testing and counseling (PITC) for all TB patients 
  • Conduct Provider Initiated TB screening (PITS) for all health facility outpatients and inpatients 

For detailed diagnosis and investigation of TB refer to ‘Manual for the Management of Tuberculosis  and Leprosy in Tanzania'. 

Pharmacological Treatment   TB treatment is divided into two phases: 

  • Initial /intensive phase, which consists of:  
  • RHZE for 2 months - new and re-treatment cases 
  • Continuation phase, which consists of: 
  • RH for 4 months - new and re-treatment cases 
  • RH for 10 months for severe forms of TB such as TB meningitis, Miliary TB and TB of the spine  

Table  7.1  Recommended  daily  doses  –  regimens  of  first-line  anti-TB  drugs  for  adults  and children

New/Retreatments

Initial Phase  

Continuation Phase  

New/Retreatments 

Rifampicin + Isoniazid + Pyrazinamide and  Ethambutol  in  fixed  dose  (RHZE)  for  2  months 

 Rifampicin + Isoniazid in fixed dose (RH) for 4 months

Table 7.2 Daily dosage of anti-TB drugs (FDCs) in new and retreatment adult patients

Body Weight

Number of tablets in initial phase: 2 months (R150/H75/Z400/E275) mg 

Number of tablets in continuation phase: 4 months (R150/H75) mg 
21–30 kg  2 2

31–50 kg 

3 

3 

51–74 kg 

4 

4 

≥75 kg 

5 

5  

Table 7.3 Daily dosages of anti-TB Drugs (FDCs) in new and retreatment paediatric patients

 

Intensive Phase *

(2 months)

Continuation phase

(4 months)

Weight (kg)

RHZ (paediatric) 75/50/150mg

Ethambutol (100mg)

RH (paediatric)

75/50 mg

For infants below 2 kg, consult a paediatric specialist, DTLC, and RTLC for treatment advice 

2-2.9kg 

 1/2 1/2 1/2

3-3.9kg 

1 

1/2

1 

4-7.9kg 

1 

1 

1 

8-11.9kg 

2 

2 

2 

12-15.9kg 

3 

3 

3 

16-24.9 kg 

4 

4 

4 

25 kg+ 

Go to adult FDCs dosages 

  
Note:
  • The oral drugs must be swallowed under observation from health facility staff or treatment supporter of his/her choice at home  

  • The oral drugs should preferably be given on an empty stomach in a fixed dose combination