MODULE C
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MDR-TB treatment is a long process in which both the health care worker and the patient must dedicate themselves to completing the treatment. If anti-TB drugs are taken incorrectly or irregularly, the patient will not be cured. Many times this treatment represents a patient’s last opportunity to receive treatment.
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Health workers must take an active role in ensuring that every MDR-TB patient takes the recommended drugs, in the right combinations, on the correct schedule, for the appropriate duration. A health worker does this by giving supervised treatment, that is, watching each patient swallow the tablets at least 6 days a week. The health worker can immediately detect any interruption in treatment and take action, such as tracing the patient and encouraging the patient to resume treatment. Supervised treatment can also build a supportive relationship that improves adherence to the treatment regimen.
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The correct treatment regimen is selected on the basis of the patient’s history of taking medications and most importantly, the results of the DST tests. The Consilium will make the final decision concerning what treatment regimen to give. The Treatment Center physician must make a note of any special circumstances that the patient may have such as HIV/AIDS, diabetes or substance dependence, among others that may necessitate special handling.
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The Category IV Treatment Card is the record of the patient’s MDR-TB treatment. Fill it out completely. Be sure to record a complete address, one that you could use to locate a patient who stops coming for treatment. Also record the name and address of a contact person who will know how to locate the patient if needed.
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All MDR-TB patients must be listed in the Category IV Register with all required information provided.
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Prior to enrollment, baseline sputum for smear, culture and DST using the Mycobacteriology Request Form must be accomplished once the patient returns to the Treatment Center. Chest x-ray and blood chemistries must also be requested in order to begin treatment.
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Look up the drug regimen approved by the Consilium for the patient. Record on the Category IV Treatment Card the drugs for both phases of treatment. Record the number of tablets and frequency for each dose.
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All patients will begin MDR-TB treatment at a Treatment Center.
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Obtain or prepare a drug pouch that will hold the patient’s daily doses of treatment for one week. On this pouch you should mark the name of the patient and the Category IV Registration No. Weekly, prepare enough doses for the patient until the next week and put them in individual plastic packets.
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Provide continuing health education to the patient and the family about MDR-TB so that they understand the disease, its public health impact, and the need to complete the treatment regimen correctly. As you continue to see the patient, reinforce messages about MDR-TB treatment and give support for continuing to take the drugs. Ask the patient to inform you of any plans to move or go away for a few days, so that you can arrange uninterrupted treatment.
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To supervise TB treatment, remember: ––
Do not make MDR-TB patients coming for supervised treatment wait in a line at the health facility.
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Watch the patient swallow the tablets.
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Record the treatment on the Category IV Treatment Card by signing the card below the date with 3 initials. (Record “X” for a missed dose.)
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If a patient has a serious and uncontrolled ADR, immediately refer the patient to the Treatment Center MD or hospital. If the patient has minor ADR, reassure the patient, give advice on how to relieve the symptoms without stopping anti-TB treatment, or give an ancillary drug to counteract the side effect. ADRs are more common in people infected with HIV, the elderly and those with comorbidities.
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Most MDR-TB patients will experience some side effects during treatment; however, only a very small proportion will require discontinuation of MDR-TB treatment.
120 Treat MDR-TB Patients
