Page 209 - fourth year book

COMMUNICABLE DISEASES (T.B)

Directly Observed Therapy (DOT)

 DOT is the most effective strategy available for controlling TB
epidemic today.
 It is a component of case management that helps ensure patients
adherence to therapy. It is the method whereby a trained health-care
worker or another trained designated person watches a patient
swallow each dose of anti-TB drugs and documents it.

 It can reduce the development of drug resistance, treatment failure,
or relapse after the end of treatment.
 It is the preferred strategy for treatment of TB disease and, if
resources allow, for LTBI treatment. However, it is mandatory when
TB treatment is given on an intermittent basis (e.g., 3 times weekly)

and for the treatment of drug-resistant TB.

The Five elements of the DOT strategy:

 Government commitment to sustain TB control activities.
 Case detection by sputum smear microscopy among symptomatic
patients

 Standardized treatment regimen of 6-9 months for at least all
sputum smear positive cases with DOT for at least the initial two
months.
 A regular, uninterrupted supply of all essential anti-TB drugs.
 A standardized recording and reporting system that allows

assessment of treatment results for each patient and of the TB control
program performance overall.

Treatment regimens for TB

I- TB Preventive treatment (treatment of latent TB Infection)

 People with latent TB infection are often prescribed treatment to
prevent developing TB disease.

 For persons who are at especially high risk for TB disease and are
either suspected of nonadherence or are given an intermittent
dosing regimen, DOT for LTBI should be considered.

178