IIb STANDARD MODE OF

CHEMIOTHERAPY

INTENSIVE PHASE OF

THERAPY

HRZEK[Cap]Fg[Pt]

(3 month)

CONTINUATION OF THERAPY PHASE

According to regimen I, IIa, or IV, depending on MBT drug susceptibility data.

III STANDARD CHEMOTHERAPY

REGIMEN

	INTENSIVE PHASE OF					CONTINUATION OF
			THERAPY
							THERAPY PHASE
	HRZE (2 month)							HR or H3R3
								(4 month);
								HE (6 month)

VI STANDARD CHEMOTHERAPY

REGIMEN

INTENSIVE PHASE OF

THERAPY

Minimum of 5 drugs for which MBT sensitivity is preserved: ZEPtK/CapFg[Cs] [Pas] (6 months)

CONTINUATION OF

THERAPY PHASE

Minimum of 5 drugs for which MBT sensitivity is preserved: ZEPtK/CapFg[Cs] [Pas] (6 months) EPtFg[Cs][Pas] (12 month)

CHOOSING A CHEMOTHERAPY REGIMEN, IT IS NECESSARY TO:

1.Determine the indications for the use of antituberculosis drugs and the appropriate chemotherapy regimen.

2.Choose a rational organizational form of chemotherapy (treatment in outpatient, inpatient or sanatorium conditions) for each patient or separate groups of patients.

3.Determine the most appropriate mode of chemotherapy in specific conditions, the most effective for a particular form of the process, for a particular tolerance of anti-tuberculosis drugs, as well as for a particular sensitivity of MBT to them.

CHOOSING A CHEMOTHERAPY REGIMEN, IT IS NECESSARY TO:

4.Ensure that patients receive the prescribed combination of TB drugs during the entire period of treatment both in hospitals and sanatoriums, as well as in outpatient settings.

5.Organize follow-up observation of patients during treatment, periodically examine them to monitor the effectiveness of treatment and evaluate its results.

6.Select rational methods of examination of the patient and determine the optimal time of their application.

CHEMOTHERAPY REGIMENS (ACCORDING TO ORDER NO. 109 OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION, MARCH 21, 2003):

1.CHEMIOTHERAPY MODE I is prescribed to patients in whom pulmonary tuberculosis has been detected for the first time and the microscopic examination of sputum shows evidence of bacterial excretion. This regimen is also administered to patients with disseminated forms of tuberculosis who have no evidence of bacterial excretion. If tuberculosis with multiple resistance to MBT to isoniazid and rifampicin is detected, the patient is prescribed the IV regimen of chemotherapy.

•Chemotherapy Mode IIA is prescribed to patients with relapsed pulmonary tuberculosis and patients who received inadequate chemotherapy for more than 1 month (improper combination of drugs and insufficient doses), with a low risk of drug resistance of MDRT. If multiple drug resistance to MBT to isoniazid and rifampicin is detected, the patient is assigned to the IV regimen of chemotherapy.

3.CHEMIOTHERAPY MODE IIB is used in patients with high risk of drug resistance of the pathogen. This group includes patients who have epidemiological (regional level of primary multidrug-resistant MBT exceeding 5%), anamnestic (contact with patients known to the dispensary who excrete multidrug-resistant MBT), social (persons, social (persons released from penitentiary institutions) and clinical (patients with ineffective treatment according to regimens I, IIa, III of chemotherapy, with inadequate treatment in previous stages, with interruptions in treatment, with disseminated, both newly detected and recurrent forms of tuberculosis) indications for prescription of this chemotherapy regime. It is the main standard treatment regimen for patients with pulmonary tuberculosis with isolation of MBT before obtaining the data of drug sensitivity study of the pathogen. It should be the main regimen for treatment of destructive pulmonary tuberculosis with bacterial excretion both in patients with newly diagnosed process and in patients with recurrent disease, and fluoroquinolones should take their rightful place in the group of basic TB drugs.

4.CHEMIOTHERAPY MODE III is administered to patients with newly diagnosed small forms of pulmonary tuberculosis in the absence of bacterial excretion. These are mostly patients with focal, limited infiltrative tuberculosis and tuberculomas, as well as patients with limited changes in the lungs of doubtful activity

4.CHEMIOTHERAPY MODE IV is designed for patients with multidrug-resistant tuberculosis of the lungs. The vast majority of such patients are patients with caseous pneumonia, fibrotic cavernous pulmonary tuberculosis, chronic disseminated and infiltrative pulmonary tuberculosis, with destructive changes. Patients with cirrhotic tuberculosis constitute a comparatively small part.

From the clinical point of view, V.Y. Mishin's classification is the most justified, according to which pulmonary tuberculosis patients isolating MBT with multidrug resistance are divided into 2 groups:

•Patients with MDR-TB to basic TB drugs. They have a more favorable prognosis, so in them it is possible to use combinations of reserve TB drugs according to the IV chemotherapy regimen.

•Patients with multidrug-resistant to MBT to a combination of basic and reserve TBT. They have unfavorable prognosis, and their treatment causes certain difficulties, because they do not have a complete set of reserve TBT.