PREPARED BY:

ATHULYA G
II YEAR MSC NURSING
UPASANA COLLEGE OF NURSING
KOLLAM
 DIRECTLY OBSERVED TREATMENT, SHORT
COURSE (DOTS OR TB- DOTS)

• NAME GIVEN BY TUBERCULOSIS CONTROL

STRATEGY RECOMMENDED BY THE WORLD
HEALTH ORGANIZATION
 THE MOST COST EFFECTIVE WAY TO STOP
THE SPREAD OF TB IN COMMUNITIES WITH A
HIGH INCIDENCE IS BY CURING IT. THE BEST
CURATIVE METHOD FOR TB IS KNOWN AS
DOTS
 WHO
 GOVERNMENT COMMITMENT

 CASE DETECTION BY SPUTUM SMEAR

MICROSCOPY

 STANDARDIZED TREATMENT REGIMEN

 DRUG SUPPLY

 STANDARDIZED RECORDING AND REPORTING

 H= ISONIAZID 75mg
 R= RIFAMPIIN 150 mg
 Z= PYRAZINAMIDE 400 mg
 E= ETHAMBUTOL HYDROCHLORIDE 275 mg
 COMBINATION OF TWO OR MORE DRUGS ARE
COMBAINED TOGETHER IN A SINGLE PILL OR
TABLET
 FIXED DOSE COMBINATION OF FOUR DRUGS

FOUR DRUGS:

• ISONIAZID
• RIFAMPICIN
• PYRAZAMIDE
• ETHAMBUTOL
 THREE DRUGS

• ISONIAZID
• RIFAMPICIN
• ETHAMBUTOL

 TWO DRUGS

• ISONIAZID
• RIFAMPICIN
INTENSIVE PHASE

 FIRST PHASE,SHORT AND AGGRESSIVE PHASE

 EARLY IN THE COURSE OF TREATMENT
 RAPIDLY KILLING OF BACILLI IN INITIAL
PERIOD
 LASTING 1-3 MONTH
CONTINUATION PHASE

 SECOND PHASE
 AIMED AT STERILIZING THE SMALLER NUMBER
OF PERSISTING BACILLI
 LASTING FOR 6-9 MONTHS
  INTENSIVE PHASE: 4FDC
(H75/R150/Z400/E275)
WEIGHT BAND NO.OF TAB TAKEN TOTAL DOSAGE NO OF STRIP
DAILY

25- 39Kg 2 56 (8Week 7Day) 4

40-54Kg 3 56 6

55-69Kg 4 56 8

>70Kg 5 56 10
-
WEIGHT BAND NO.OF TAB TAKEN TOTAL DOSAGE NO OF STRIP
DAILY

25- 39Kg 2 112 8

(16Week 7day)

40-54Kg 3 112 12

55-69Kg 4 112 16

>70Kg 5 112 20
-
WEIGHT BAND NO.OF TAB TAKEN TOTAL DOSAGE NO OF STRIP
DAILY

25- 39Kg 2+SM 0.5gm 84(12week 7days) 6+ 56 vial SM

SM 56dose

40-54Kg 3+ SM 0.75gm 84 9+ 56 vial SM

55-69Kg 4+ SM 1gm 84 12+ 56 vial SM

>70Kg 5+ SM 1gm 84 15+ 56 vial SM

-
WEIGHT BAND NO.OF TAB TAKEN TOTAL DOSAGE NO OF STRIP
DAILY

25- 39Kg 2 140 (20 week 10

7day)

40-54Kg 3 140 15

55-69Kg 4 140 20

>70Kg 5 140 25
-
WEIGHT BAND INTENSIVE PHASE NO STRIP AND
TAB
(3FDC+E)

3FDC E

H50/R75/Z150 100mg

4-7kg 1 1 2*28+56

8-11kg 2 2 4*28+112

12-15kg 3 3 6*28+168

16-24kg 4 4 8*28+224

25-29kg 3+1A 3 6*28+16+56A

30-39kg 2+2A 2 4*28+112+112A

WEIGHT BAND CONTINUATION PHASE NO STRIP AND
TAB
(2FDC+E)
2FDC E
H50/R75 100mg
4-7kg 1 1 4*28+112
8-11kg 2 2 8*28+224
12-15kg 3 3 12*28+336
16-24kg 4 4 16*28+448
25-29kg 3+1A 3 12*28+336+11
2A
30-39kg 2+2A 2 8*28+224+224
A
WEIGHT BAND INTENSIVE PHASE 84 DOSES NO STRIP AND TAB
(3FDC+E)

3FDC E
H50/R75/Z150 100mg
4-7kg 1 1+100mg SM 3*28+84
8-11kg 2 2+150mg SM 6*28+168
12-15kg 3 3+200mg SM 9*28+252
16-24kg 4 4+300mgSM 12*28+336
25-29kg 3+1A 5+400mg SM 9*28+252+84A
30-39kg 2+2A 6+500mg SM 6*28+168+168A
WEIGHT BAND CONTINUATION PHASE 140DOSES NO STRIP AND
TAB
(2FDC+E)
2FDC E
H50/R75 100mg
4-7kg 1 1 5*28+140
8-11kg 2 2 10*28+280
12-15kg 3 3 15*28+420
16-24kg 4 4 20*28+560
25-29kg 3+1A 3 159*28+420
30-39kg 2+2A 2 10*28+280+
280A
 STORE BELOW 25 DEGREE C
 IN DRY PLACES
 PROTECT FROM LIGHT
 RIFAMPICIN SHOULD BE USED WITH EXTREME
CARE IN PATIENTS KNOWN TO HAVE LIVER
DISEASES OR DYSFUNCTION

 IT MAY CHANGE THE COLOUR OF SWEAT AND

URINE
NEW GUIDELINES PREVIOUS GUIDELINES
DAILY REGIMEN INTERMITTENT REGIMEN

ETHAMBUTOL IN CP OF BOTH ETHAMBUTOL IN CP OF CATEGORY II

CATEGORIES IAND II REGIMEN REGIMEN ONLY

FIXED DOSE COMBINATION AS PER NO FIXED DOSE, LIMITED BAND

WEIGHT BAND

FOLLOW UP CLINICAL, LABORATORY FOLLOW UP LABORATORY ONLY

INVESTIGATION

LONG TERM FOLLOW UP UPTO 2YEAR NO LONG TERM FOLLOW UP

 CLINICAL FOLLOW UP

 FOLLOW- UP LABORATORY INVESTIGATION

 LONG TERM FOLLOW- UP

 SHOULD BE AT LEAST MONTHLY

 TO OBSERVE IMPROVEMENT OF CHEST

SYMPTOMS, WEIGHT GAIN

 CONTROL CO- MORBID CONDITIONS SUCH

AS HIV AND DIABETES
 SPUTUM SMEAR EXAMINATION AT THE END
OF IP AND AT THE END OF TREATMENT

 AT THE COMPLETION OF TREATMENT,

SPUTUM SMEAR AND CULTURE SHOULD BE
DONE FO EVERY PATIENT

 CHEST X- RAY DONE IF REQUIRED

 AFTER COMPLETION OF TREATMENT, THE
PATIENT SHOULD BE FOLLOWED UP THE END
OF 6, 12, 18 AND 24 MONTHS

 ANY CLINICAL SYMPTOMS SUCH AS COUGH,

SPUTUM MICROSCOPY OR CULTURE SHOULD
BE DONE