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  • Management of EPTB

    Learning Objectives

    Principles of management of EPTB (using the same drugs and same duration, some exceptional cases treatment can be extended, emphasis on clinical improvement and relevant investigations when indicated)


​The management principles of Extrapulmonary Tuberculosis (EPTB) are shown in the figure below.

Figure: Ten principles about what every EPTB patient in India needs as a basic standard of care

Abbr: CBNAAT:Cartridge-based Nucleic Acid AMplification Test; PTB: Pulmonary TB; NTEP: National TB Elimination Programme


Diagnosis of EP-TB

  • All efforts need to be made to get a microbiological confirmation whenever a sample is available. 
  • Clinical diagnosis can be made by treating physician based on the clinical features, lab investigations, imaging studies and by ruling out other causes


Treatment Regimen and Duration for EPTB

The treatment regimen and schedule for EPTB cases will remain the same as for pulmonary TB (2HRZE/ 4HRE). However, the duration of the continuation phase in EPTB may be extended in special situations such as TB Meningitis, bone and spine TB etc.


Role of Surgery in EPTB Cases

  • Surgery is sometimes required for the diagnosis of EPTB. It is reserved for management of late complications of the disease.


Monitoring Treatment Response

  • Response to treatment in EPTB may be best assessed clinically. Clinical follow-up is the most important criterion for the follow-up of EPTB patients. The clinician can assess the patient’s condition by checking weight gain and a decrease/ increase in presenting clinical symptoms.
  • Investigations such as Acid-fast Bacilli (AFB) microscopy, chest X-ray, liver function tests, serum creatinine, and USG-abdomen can be used to monitor the treatment status.

The treatment support and other monitoring activities remain the same as for pulmonary TB.





Question​ Answer 1​ Answer 2​ Answer 3​ Answer 4​ Correct answer​ Correct explanation​ Page id​ Part of Pre-test​ Part of Post-test​
What is the standard treatment duration for most EPTB cases? 2 weeks 1 month 6 months 3 years 3 The treatment regimen and schedule for EPTB cases will remain the same as for pulmonary TB (2HRZE/ 4HRE).   Yes Yes
In which cases can the treatment duration exceed 6 months in EPTB? TB meningitis TB of the bone and joint Depending on the clinician’s decision All of the above 4 EPTB treatment duration can be extended beyond 6 months in TB meningitis, TB of bone and joint (including TB otitis media), and if recommended by the clinician.   Yes Yes




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