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Pre treatment evaluation of DRTB cases
Learning ObjectivesPre treatment evaluation of a DRTB cases
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Let us understand the objective and importance of Pre-treatment Evaluation (PTE) of Drug-resistant TB (DR-TB) patients.
PTE Objective
Drugs used for the treatment of drug-resistant TB have significant adverse effects. Hence, there is a need for PTE to rule out any underlying condition at the baseline, like co-morbid conditions, radiological abnormalities, Electrocardiogram (ECG) changes, or biochemical derangements.
PTE is essential to identify:
- The patient's eligibility for initiation of a particular regimen
- Patients who require special attention during treatment
- Regimen modifications from the beginning of treatment
Important Points
- In the majority of Multidrug-resistant (MDR)/ Rifampicin-resistant Tuberculosis (RR-TB) patients, PTE can be done on an outpatient basis.
- The District TB Officer (DTO) and Medical Officer of the TB Unit (MO-TU) can arrange for PTE at the Nodal and District DR-TB Centre (N/DDR-TBC) or at the sub-district level health facility, wherever feasible.
- No additional investigations are required for H Mono/ Poly DR-TB patients unless clinically indicated.
- The PTE carried out at the time of treatment initiation can be considered valid for 1 month from the date of the test result and the patient can be re-initiated on a subsequent regimen considering the previously conducted PTEs.
- Active Drug Safety Management and Monitoring (aDSM) treatment initiation forms are required to be completed for all DR-TB patients at the time of initiation of each new episode of treatment.
- PTE should include a thorough clinical evaluation by a physician and expert consultation as per the need.
- Laboratory-based tests should be performed based on the drugs used in the treatment regimen.
- Pre-treatment evaluation should be made available free of charge to the patient.
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Resources
- Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
- WHO Consolidated Guidelines on Tuberculosis: Module 4 -Treatment: Drug-resistant TB Treatment, 2020.
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