This National Tuberculosis management Guidelines 2019 is to provide basic information about TB and its management to all health workers in Nepal. Early detection, appropriate diagnosis and timely treatment of TB result in good treatment outcomes. Health workers need to be equipped with the right information on the diagnosis and treatment of TB. Poor management of TB results in death and creates drug resistant (DR) TB which is very hard and costly to treat resulting in often poorer outcomes.
All health workers in Nepal regardless of their involvement in TB services should be aware of TB, its transmission and prevention and its diagnosis and management. Health workers managing TB patients need proper guidance in diagnosis and treatment of TB and it is for this purpose that this guideline is produced.
In developing this guideline, the National TB Program takes into consideration the emerging problems of TB/HIV and DR TB as well as other revisions including Latent TB infection made to TB management by World Health Organization. This guideline is therefore, an update from the 2012 General Manual (Third Edition) and the following are the major changes to TB management for Nepal:
Major Changes in National Tuberculosis management Guidelines 2019 of Nepal
- Only 2 sputum samples required for initial diagnosis of TB.
- Same-day diagnosis of TB by Microscopy (2 samples same day-1 hour apart)
- Only 1 sputum sample required for follow up examination.
- Even new presumptive TB cases should have access to GeneXpert diagnosis whereever it is
- Treatment is not extended at the end of the intensive phase, even though the sputum follow
up examination result remains positive at the end of two months, continuation phase is
commenced regardless of whether the sputum is positive or not.
- Streptomycin containing Category II regimen for retreatment cases will No Longer be used in
New definitions On National Tuberculosis management Guidelines 2019
- TB suspect is changed to Presumptive TB
- Previously treated patients’ definitions have been changed and are based on the outcome of their most recent course of treatment and are independent of bacteriological confirmation or site of disease.
- The treatment regimen for re-treatment TB cases has been removed.
- All previously treated TB patients will receive new treatment regimen and will be screened for drug resistant TB
- o Recording and reporting forms have been edited to suit new definitions and change in
the treatment regimen