9. Monitoring treatment response

This chapter focuses on monitoring the progress of treatment and identifying any problems that may arise during treatment of DS-TB. Examples of such problems are adverse drug reactions or delayed response to treatment, which might require additional investigations to decide whether to continue the therapy or change the treatment strategy.

All patients should be monitored to assess their response to therapy. Regular monitoring of patients also facilitates adherence to treatment and completion of treatment.

Although people with DS-TB are much less likely than those with MDR-TB to fail treatment, it is important to outline the principles of effective monitoring where drug-resistance and possible failure are suspected. Regular clinical examination (with monitoring of body weight), CXR and laboratory monitoring make it easier to determine whether something is wrong and thus take rapid action.

All patients, their treatment supporters and health workers should ideally be instructed to report the persistence or reappearance of symptoms of TB (including weight loss), slow clinical improvement, symptoms of adverse drug reactions or treatment interruptions. Patient weight should be monitored each month, and dosages should be adjusted if weight changes. When possible, radiological monitoring may also be useful. Regular clinical examinations should be performed by the treating physician.

A written record of all medications given, bacteriological response and adverse events should be maintained for every TB patient on the TB treatment card.

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