The classic symptoms of TB – cough, sputum production, fever and weight loss – generally improve within the first few weeks of treatment. Cough and sputum production can persist after sputum conversion in patients with extensive lung damage (often due to late diagnosis), but even in those with extensive lung damage, improvement is usually seen within 1–2 months of effective treatment. Persistent fever, weight loss or recurrence of any of the classic symptoms of TB should prompt investigation for possible treatment failure, undetected resistance to one or more drugs in the current treatment regimen or untreated comorbidities. The recurrence of TB symptoms after sputum conversion may be the first sign of treatment failure. For children, height and weight should be measured monthly to ensure that they are growing normally. Normal growth rate usually resumes after a few months of successful treatment. For adults, weight should also be recorded monthly (height is only recorded at the start of treatment, to calculate BMI).
The frequency of clinical visits depends on the patient’s clinical condition and evolution. On average, for an outpatient with no specific problems, clinical examination is usually done every week during the first month and once per month thereafter if the patient is stable. More frequent clinical examinations may be necessary, depending on the clinical condition of the patient.
At every visit, the patient should be asked about the occurrence of adverse events; also, any potential difficulties in treatment adherence should be discussed with the patient and their treatment supporter
Clinical visits should coincide with bacteriological and clinical laboratory examination schedules, to limit time and transportation constraints for the patient.
In extrapulmonary DS-TB, it is essential to monitor the clinical evolution to assess the treatment response because, in general, bacteriological monitoring is difficult.