‬Recent Changes in Tuberculosis Guidelines 2016

1.3 new goals – cure, prevent resistance and break chain of transmission.

2. Introduction of daily regime.

3. Definition and treatment of mono and polyresistance apart from mdr and xdr tuberculosis.

4. Treatment in cat 1 – 2 (hrze) + 4 (hre): continue ethambutol in continuation phase too.

5. Treatment in cat 2 – 2 (hrzes) + 1 (hrze) + 5 (hre).

6. Introduction of bedaquiline as a new drug. Atp synthase inhibitor specifically targets myc. Tb. Indicated in age more than 18 years. Contraindicatef in pregnancy and those taking hormonal ocp. It may be given in patients with stable arrythmia.

7. Definition of presumptive tuberculosis. Duration > 2 weeks etc.

8. New algorithm to diagnose tuberculosis – pulmonary, extrapulmonary, drug resistant.

9. Introduction of newer molecular methods like cbnaat and line probe assay in diagnostic algorithm apart from smear microscopy and chest xray.

10. Diagnosis of tuberculosis based on x-ray will be called as clinically diagnosed tuberculosis.

11. Sputum should be around 2ml and preferably be mucopurulent.

12. Follow up – new and previously treated drug sensitive pulmonary tuberculosis – no need to extend intensive phase, sputum microscopy at end of ip and end of treatment, weight monthly, chest x-ray if required.

13. Follow up – mdr tuberculosis – sputum smear monthly 3, 4, 5, 6, 7 months in intensive phase and at 3 months interval in continuation phase 9, 12, 15, extend ip phase by maximum 3 months total of 9 months.
Some more additions to it, adding here which might help to pg students. 
1) monitoring health status of tb treated patients (for recurrence of tb) for 24 months after treatment 
2) online monitoring of treatment adherence through 99dots programme (currently it is on pilot basis running for tb-hiv patients)
3) intensified tb case finding in clinically, socially and geographically vulnerable population. It's a provider initiated activity. 
4) now'tb suspect' term is replaced by'presumptive tb case.
5) in diagnostic algorithm sputum examination along with chest x-ray is recommended. 
6)'nsp' term is replaced by'microbiologically confirmed case'
7) nsn and others r called now onwards'clinically diagnosed tb' case. (terms replaced) 
8) definitions of cured, defaulted, treatment completed, failure, failure to respond, loss to follow up are somwhat changed. 
9) cat i, cat ii, cat iv terminologies r obsolete n replaced by drug sensitive (new or previously treated) and drug resistant tb categories.