The directly observed treatment short course (DOTS) strategy adopted by the WHO in 1990 is currently being used by many countries tuberculosis control programme, including the Nigerian Tuberculosis control programme.
DOTS strategy requires that the intensive phase of the treatment should be given under strict supervision by a trained observer in order to ensure compliance and significantly reduce the rates of relapse and drug resistance.
In Nigeria, the national tuberculosis control programme makes use of four drugs, namely, rifampicin, isoniazide, pyrazinamide and ethambutol for the first two months (intensive phase) and INH and ethambutol or rifampicin for the continuation phase in newly diagnosed (previously untreated) case including tuberculosis meningitis and military tuberculosis (2ERZ/6HE or 4HR).
A failure case is therefore, one that continues to be positive after five months of adequate chemotherapy. A relapse is a patient who was once declared cured but later again became sputum positive. A defaulter is a patient who has previously taken anti tuberculosis drugs for more than one month and defaulted. A chronic excretor is one who has excreted tubercle bacilli for more than two years. These cases should receive-re-treatment regimen, based if possible on sensitivity test.
These include the routinely administered special dietary supplements of vitamins and mineral preparations, haematinics and cough medicines. These are not very relevant and should be given with sufficient explanation or else they may confuse the patient’s medicaments as the patient may fail to realize that it is the anti tuberculosis medicaments that are vital and as a result concentrate more on these less important not so relevant drugs.