FOLLOW UP OF TREATMENT

FOLLOW UP SMEARS:
The most important method of follow up of cases is through sputum smear examinations. For smear positive patients [category I] follow up smears are taken at 2^nd month , 4^th month and at the end of treatment. For smear negative patients [category III] the follow up smears are performed at 2^nd month and at the end of treatment. For Category II patients , follow up smears are taken at 3^rd month , 5^th month and at the end of treatment (8^th month). The principle behind this particular schedule is that all patients put on ATT under the RNTCP should have a sputum examination at the end of the intensive phase and at the end of treatment. In addition , sputum positive patients should have another sputum smear 2 months after the end of the intensive phase. After a patient completes treatment and is declared cured follow-up is not required. He should be advised to report only if symptoms suggestive of tuberculosis recur.

What if follow up smears are positive?
If the follow up smear at the end of the intensive phase is positive for Category I and Category II patients, continue the intensive phase medications for one more month and then at the end of this period  test sputum. Most patients will become negative by this time, but if they don't , start the continuation phase and test sputum after 2 months. Any patient in these two categories who remain sputum smear positive after 5 months of treatment is categorized as Failure of Treatment. Cat I failures are put on Cat II treatment. Cat II failures have a long and difficult road ahead of them using multiple drugs and protracted periods of treatment. Such drugs are not provided under the RNTCP.
   In case of Category III patients, if the first follow up smear is positive they are deemed to be  Treatment Failure and begun afresh on Cat II treatment.

Pulmonary patients who interrupt treatment
 The health staff or community health worker makes a visit to the patient's house no later than a day after the patient was due. If a patient in the intensive phase does not take medication as scheduled, he should be traced and given the medication on the next day. The medication for the following day is then given as scheduled. If a patient completely misses any dose of medicine, these doses must be made up at the end of the scheduled period. The number of doses must be strictly adhered to.
   Sometimes a patient may stop taking the drugs. When such a patient returns to treatment after weeks or months of default, the treatment prescribed under the RNTCP depends on the type of patient, the duration of treatment taken, the length of the interruption, and whether he is smear positive or smear negative when he returns for treatment. Guidelines for their treatment have been provided under the RNTCP, but is beyond the scope of this website (at least for now).
We will however be happy to clear any of your doubts regarding this or any other aspect of RNTCP. Just click on one of the email icons to send us mail.

OUTCOMES OF TREATMENT
RNTCP defines six different types of outcomes to anti-TB treatment.
Cured: Initially smear positive patient who has completed treatment and had negative sputum smears, on at least two occasions, one of which was at completion of treatment.
Treatment completed: Smear positive case who has completed treatment, with negative smears at the end of the initial phase  but none at the end of treatment or  Smear negative patient who has received a full course of drugs and has not become smear positive during or at end of treatment or Extrapulmonary TB patient who has received a full course of treatment and has not become smear positive during or at end of treatment.
Died: Patient who died during treatment, regardless of cause
Failure: Smear positive case who is smear positive at 5 months or more after starting treatment or A patient who was initially smear negative who becomes smear positive anytime during treatment.
Defaulted: A patient who, at any time after registration, has not taken anti-TB drugs for 2 months or more consecutively.
Transferred out: A patient who has been transferred to another Tuberculosis Unit/District and his treatment results are not known.
 
                           TUBERCULOSIS IN CHILDREN
This area in the diagnosis and treatment of childhood diseases is a perpetual "banana skin" for some of us who do not specialize in the diseases of children. This " blind spot" is apparent in the number of children who are put on ATT based on "high esr" , "lymphocytosis"  and the like. Our advice in this regard is , experto crede - trust the one with  experience (the paediatrician , in short !)
RNTCP guidelines:
Make sure that all children under the age of 6 years who have a family member with smear positive tuberculosis are screened for symptoms. If the child has symptoms, an MO (preferably in consultation with a peadiatrician ) will examine him and if he decides that the child has TB, then a full course of treatment is given (doses appropriate for children ; Catgegory III). If the child does not have symptoms of tuberculosis he receives INH 5mg/day for 3 months ,at the end of which a Mantoeux test is done. If the test shows an induration of more than 6 mm, continue INH chemoprophylaxis for  another 3 months. If the induration is less than 6 mm, then stop the chemotherapy and vaccinate him with BCG (if he has not been previously vaccinated). In areas where no tuberculin test is available, all asymptomatic children under 6 years who give a history of contact with adult sputum positive TB should receive 6 months of INH chemoprophylaxis.                                      
                                                                                                                 
                                                                               
             
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