PE31.3-4 | Tuberculosis Management Program — Summary & Reflection

KEY TAKEAWAYS

TB management in children requires both a correct drug regimen and a functional programme structure. The current NTEP regimen for drug-sensitive TB is 2HRZE + 4HRE — daily, using weight-band paediatric FDC tablets (never thrice-weekly — the old RNTCP intermittent regimen is obsolete). Extended regimens apply for TBM and osteoarticular TB (12 months). Directly Observed Therapy (DOT) is the cornerstone of treatment adherence; every dose must be watched. All cases are notified via Nikshay. Prevention rests on three pillars: BCG at birth (NIS, ~80% protection against miliary/TBM), IPT (isoniazid 10 mg/kg/day × 6 months) for child contacts <5 years and all TST-positive contacts without active disease, and household infection control + nutritional rehabilitation. Drug-resistant TB (rifampicin resistance on CBNAAT) requires referral to NTEP DR-TB centre — never treat MDR-TB with first-line drugs.

REFLECT

Return to the case in the opening scenario: the child not improving at 2 months because of irregular dosing and incorrect weight-based prescription. Having worked through this module, answer: (1) What was the correct weight-band dose for a 5-year-old on the standard NTEP regimen? (2) What does a sputum culture still positive at 2 months tell you, and what are the possible causes in this case? (3) How would you restructure the DOT arrangement for this family, and who should be designated as the DOT provider? (4) Are the younger siblings at risk? What preventive action is indicated for them? Reflect on how the programmatic elements — DOT, weight-based dosing, Nikshay notification, contact screening — are not bureaucratic add-ons but directly determine whether this child is cured or becomes an MDR-TB case.