Terapéutica

guidelines
Fourth edition

TreaTmenT of Tuberculosis

Treatment of tuberculosis

Guidelines
Fourth edition

WHO Library Cataloguing-in-Publication Data: Treatment of tuberculosis: guidelines – 4th ed. WHO/HTM/TB/2009.420 1.Antitubercular agents – administration and dosage. 2.Tuberculosis, Pulmonary – drug therapy. 3.National health programs. 4.Patient compliance. 5.Guidelines.I.World Health Organization. Stop TB Dept. ISBN 978 92 4 154783 3 (NLM classification: WF 360)

© World Health Organization 2010 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translateWHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of anycountry, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to othersof a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied.The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Designed by minimum graphics Printed in ….

::

Contents
Abbreviations Acknowledgements Foreword Executive summary 1. Introduction 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 2.1 2.2 2.3 2.4 2.5 2.6 2.7 3.1 3.2 3.3 3.4 3.5 3.63.7 3.8 Chapter objectives Purpose of the guidelines Target audience scope Why a new edition? Methodology international standards for Tuberculosis Care expiry date Chapter objectives Purposes of defining a TB case Case definitions Anatomical site of TB disease Bacteriological results History of previous treatment: patient registration group HiV status Chapter objectives Aims of treatment essentialanti-TB drugs standard regimens for defined patient groups new patients Previously treated patients and multidrug resistance standard regimens for previously treated patients Overall considerations in selecting a country’s standard regimens
iii

vii viii ix 1 15 15 15 15 15 15 18 21 21 23 23 23 23 24 25 26 28 29 29 29 29 31 32 36 38 42

2. Case definitions

3. Standard treatment regimensTrEaTmEnT of TubErCuloSIS: GuIdElInES

4. monitoring during treatment 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 Chapter objectives Monitoring the patient Assessing treatment response in new and previously treated pulmonary TB patients, and acting on the results extrapulmonary TB Recording standardized treatment outcomes Cohort analysis of treatment outcomes Management of treatment interruptionPrevention of adverse effects of drugs Monitoring and recording adverse effects

53 53 53 53 57 57 57 59 59 60 60 65 65 65 67 67 69 69 71 71 72 72 75 75 75 77 78 80 83 83 83 84 86

4.10 symptom-based approach to managing side-effects of anti-TB drugs 5. Co-management of HIV and active Tb disease 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 Chapter objectives HiV testing and counselling for all patients...