Treatment of tuberculosis: guidelines for national programmes

Expert practical guidelines for the treatment and control of tuberculosis within the context of national TB programmes. Advocates standardized short-course chemotherapy regimens, applied under proper case management conditions, and making the identification and cure of smear-positive pulmonary TB the first priority of any national programme

Manual gives programme managers, policy-makers, and clinicians a clear - and proven - approach to TB control that relies on precise case definitions, distinct treatment categories, and standardized treatment regimens using essential anti-TB drugs. Since 95% of the global TB burden occurs in low - and middle - income countries, issue of cost-effectiveness are also repeatedly addressed.

The manual has eight concise chapters. Background information is provided in the first, which present basic facts about the global TB epidemic and explain how control can be achieved through universal application of the WHO recommended DOTS (directly-obtserved treatment, short course) strategy. Further details about the DOTS strategy are presented in chapter two, which elaborates a framework for TB control and describes the components, targets, and policies of effective national programmes.

Against this background, the main part of the manual provides a didactic guide to the diagnosis and clinical management of cases. Chapter three, on case definitions, explains how to diagnose TB, define the type of case, and then match the case definition to one of four treatment categories. Standardized treatment regimens are covered in the next chapter, which describes the essential anti-TB drugs, presents the rationale for standardized treatment regimens, and discusses recommended and alternative regimens for each of the four treatment categories. Treatment regimens in special situation, such as pregnancy, lactation, and liver or renal disorders, are also described.

Chapter five explain hot to monitor and record the response to treatment, especially in sutum smear-positive TB patients, and how to monitor and manage drug-induced toxicity. The vital importance of treatment adherence is addressed in chapter six, which includes practical examples of ways to ensure poth the regular supply of essential drugs and their appropriate use. The important issue of drug quality and the bioavailability of fixed-dose drug combinations are also considered. [author]