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Patient-wise Drug Boxes: Packing Instructions
Learning Objectives-
Packaging of loose drugs into monthly patient-wise boxes should be done under the guidance of those in charge of drug logistics at the state and district levels.
Patient-wise drug box preparation should be done for the following Drug-resistant TB (DR-TB) regimens:
- Shorter oral Bedaquiline-containing Multidrug-resistant/ Rifampicin-resistant TB (MDR/RR-TB) regimen
- Longer oral Multi (M)/ Extensively Drug-resistant TB (XDR-TB) regimen
- Isoniazid (H) mono/poly DR-TB regimen
Packaging Instructions
Patient-wise drug boxes are prepared as per the type of DR-TB regimen and weight bands. One monthly pouch of the capsule Cycloserine (Cs) and tablet Ethambutol (E) each, should be made from a plastic bag with a zip lock facility in which 1 gm pouch of silica gel desiccant should be kept.
Figure 1: Isoniazid (H) Mono/ Poly Regimen DR-TB Treatment Box |
Figure 2: Isoniazid (H) Mono/ Poly Regimen DR-TB Label |
In each Type A box, one pouch of silica gel desiccant of 4 gm weight should also be kept.
Labels for the boxes should be developed with the following information (Figures 2 and 3):
- Item-wise name of drugs with a quantity of each drug in the box
- Batch number and Date of Expiry (DOE) of the individual drugs
- DOE of boxes, with expiry date of the drug having the shortest expiry date
- Date of issue of the box from the State Drug Store (SDS)
- Serial number of the box
- Storage instructions on the box for ensuring adequate precautions in storage of the drugs, especially at the treatment supporter level. Some suggested messages are:
- “Store in a cool and dark place, preferably in a clean cupboard”
- “Do not expose to direct sunlight”
- “Keep away from children/unauthorized persons”
- “Box to be closed properly every time after the withdrawal of drugs”.
Figure 3: Prototype of a Label (Type A box for shorter DR-TB regimen for the weight band - 46 to 70 kg)
Resources
- Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
- Standard Operating Procedure Manual - Procurement & Supply Chain Management, MOHFW, GOI.
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