Monitoring of Treatment by Smear and Culture

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Smear microscopy and culture play an important role in monitoring the response to TB treatment. In NTEP, smear microscopy and culture has been prescribed to monitor the treatment response and at specific time points based on different treatment regimens. The programme also explains the actions that need to be taken based on the follow-up results.

Monitoring of tuberculosis treatment is shown in the table below.

Table: Monitoring of TB treatment by smear and culture
TYPE OF TREATMENT	MONITORING BY SMEAR	MONITORING BY CULTURE	ACTION TO BE TAKEN FOR FOLLOW UP
Drug Sensitive Pulmonary TB	One sputum smear examination at time of completion of the intensive phase (IP) of treatment and at the end of treatment	-	If sputum is positive anytime during treatment, then drug susceptibility testing (DST) is to be done. Further treatment is guided by the DST pattern.
H mono/poly DR-TB	Monthly from month 3 onwards till the end of treatment. Conduct smear microscopy within 7 days, if the smear at month 4 or later is positive to rapidly ascertain bacteriological conversion/reversion	At the end of month 3, end of treatment (month 6 and/or 9 if applicable)	If the culture results of month 3 are positive, the culture is repeated to rapidly ascertain bacteriological conversion/ reversion. If the repeat specimen is culture negative, culture is done at the end of treatment
Shorter oral Bedaquiline-containing MDR/RR-TB regimen	Monthly from 3rd month onwards till end of IP monthly in extended IP only if previous month is smear positive ( S+ve). Conduct SM within 7 days, if the smear at 6 months is positive to rapidly ascertain bacteriological conversion/reversion.	At the end of month 3, end of month 6 and/or end of treatment.	If the culture results of month 6 is positive, collect one repeat sample immediately to rapidly ascertain the bacteriological conversion/reversion. If the repeat sample is culture negative, then conduct an end of treatment specimen collection.
Longer Oral M/XDR-TB Regimen	Examine sputum smear within 7 days and every time C&DST is done.	Monthly from month 3 onwards to end of 6 months or 7 or 8 if the previous month’s culture is positive; Quarterly month 6 or 7 or 8 onwards based on previous month’s culture results	If the smear/culture results of month 6 or any of the quarterly culture is positive, repeat culture is done to ascertain bacteriological conversion/reversion and if the repeat specimen is culture negative, then culture is done the subsequent quarter or end of treatment