DOTS THERAPY (Directly Observed Therapy , Short Course). "A THERAPY FOR TUBERCULOSIS"

TUBERCULOSIS

It is a chronic granulomatous inflammatory disorder. It is caused by bacteria Microbacterium tuberculosis.

It is called as " king of diseases " is it is very much difficult to treat.

The bacteria that causes TB are spread when an infected person cough or sneezes.

DOTS THERAPY

DOTS stands for "Directly Observed Treatment Short course)

It was developed by Karel Styblo of International Union against TB and lung diseases in 1970 primarily in Tanzania

TB requires at least six months for the treatment

if treatment is incompleted or discontinued the patient may not be cure and the drug resistance may developed

Directly Observed therapy is a specific strategy which is done to improve adherence by requiring health workers community volunteers for family members to observe and record patients taking each dose.

COMPONENTS OF DOTS

It has five main components :-

- Government Commitment

Here the Government of the particular region establish centralised and prioritised system of TB monitoring recording and tracing.

- Case Detection

The case this section is done by sputum smear microscopy.

- Standardized Treatment

it includes 6 to 9 months therapy which is observed by a Health Care worker or community health worker for at least the first two months.

- Drug Supply

- A standardized recording and reporting system that allows assessment of treatment result.

PHASES OF DOTS THERAPY

There are two phases of DOTS Therapy :-

INTENSIVE PHASE :-

It is of two to three months of duration. in this space the patient has to swallow medicine under the observation of health worker during IP

Medicines are taken 3 times a week on alternative days

If the sputum is negative for bacteria after IP Continuation Phase is started..

CONTINUATION PHASE :-

This phase is of 4 to 5 months duration.

Here the patient is provided with a weekly blister pack to take home.

The medications from the blister pack are taken on alternative days three times a week and in the remaining days vitamin tablet are taken.

The first dose of the weekly blister pack is taken under direct observation of the health worker.

Empty blistera packs are collected to ensure that the medications are taken at home by the patients

DRUG USED IN DIFFERENT PHASES OF DOTS THERAPY

DRUGS TAKEN IN INITIAL PHASE

- ISONIAZID (H)

- RIFAMPICIN (R)

- PYRAZINAMIDE (Z)

- ETHAMBUTOL (E)

- PYRIDOXINE  (Vit. B6) 100 mg/ day

DRUGS TAKEN IN CONTINUATION PHASE

- ISONIAZID

- RIFAMPICIN

- PYRIDOXINE (Vit B6)

OBJECTIVES OF TB TREATMENT

- TO KILL ACTIVELY DIVIDING BACTERIA - RELIEVE SIGNS AND SYMPTOMS - ISONIAZID

- TO KILL SLOWLY DIVIDING AND PERSISTENT         BACTERIA -  ERADICATE THE DISEASE AND     PREVENT RELAPSE -  RIFAMPICIN AND PYRAZINAMIDE

- TO PREVENT EMERGENCE OF DRUG           RESISTANCE - ETHAMBUTOL

ADVANTAGES OF DOTS THERAPY

- It ensure that patient completes an adequate     regimen

- It lets the health care worker to monitor patient   regularly for side effects and response to therapy

- It helps the health care worker to solve problems that might interrupt the treatment

- It helps in ensuring that the patient takes every dose of medicines and also it helps patient to become noninfectious Sooner.

DISADVANTAGES OF DOTS THERAPY

- It is the time consuming therapy

- It is labour intensive

- It can be perceived as demeaning or punitive