Patient categories and treatment regimens
In order to establish treatment priorities, the WHO recommends that TB patients should be classified into four categories, as shown in Table 14.2. Patients are started on anti-TB drugs according to their category.
You should refer patients with the following symptoms urgently to hospital for proper management:
- Coughing up blood
- Increasing breathlessness
- Suddenly increasing chest pain
- Progressively deteriorating general condition.
Table 14.2 Treatment category by type of patient.
| Treatment category | Type of patient |
|---|---|
| I |
Sputum smear-positive; new Sputum smear-negative; seriously ill, new EPTB; seriously ill, new Others (e.g. TB with HIV infection) |
| II |
Sputum smear-positive; relapse Sputum smear-positive; failure Sputum smear-positive; return after default PTB patients who become smear-positive after two months of treatment (case definition = other) Return after default from re-treatment Relapses after re-treatment |
| III |
Sputum smear-negative, not seriously ill, new EPTB, not seriously ill, new |
| IV | Chronic and drug resistant-TB cases (still sputum positive after supervised re-treatment) |
Always keep in mind that patients with severe forms of EPTB may come to you with the types of symptom mentioned in Study Session 13, Table 13.2 — perhaps with TB affecting the lining of the brain (TB meningitis) or the kidney (renal TB) or the spine (spinal TB). You must refer such patients to the hospital for proper management because they need additional medication and/or special care. Disseminated TB is often used to describe TB involving two or more organs or tissues of the body and it is considered as one of the severe forms of TB.