TB-DOTS | PHILIPPINES 2022

Tuberculosis Treatment in the Philippines

Prepared by: Michael Z. Cayabyab, RN, MSN (inp.)

Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis. In the Philippines, it’s

most known to affect the lungs (pulmonary TB), but the bacteria can also infect the other organs
of the body (extra-pulmonary TB).

Active TB Infection vs Latent TB Infection

Did you know that you can get TB infection without exhibiting any symptoms? This is called latent
TB infection and it happens when you breathe in the Mycobacterium tuberculosis, but your body
is able to fight the bacteria and stop them from thriving.

During a latent TB infection, either of these two things could happen:

• The bacteria are detected through routine check-ups and the doctor prescribes you with
medications to kill the germs and prevent the development of TB disease in the future.
• The bacteria remain in the body, dormant, but alive. You wouldn’t feel sick and you are not
contagious, meaning you cannot spread the bacteria to other people.
• However, when your body becomes unable to fight off the latent infection, it can turn into
an active TB infection. When that happens, you would exhibit symptoms, like cough, fever,
and weight loss. Moreover, you could spread the bacteria to other people.
• Having an active TB infection means you need to choose among the available tuberculosis
treatment in the Philippines.

Reminder:
• Please note that the time before a TB infection develops into an active disease varies.
• It could happen immediately after the infection, before the body has the chance to fend
off the bacteria. This is common among vulnerable people, like babies, seniors, and those
with chronic illnesses.
• Likewise, it could happen in months or years after getting the bacteria.
• Tuberculosis in the Philippines, An Overview
• Before we move on to the discussion about the tuberculosis treatment in the Philippines,
let’s first talk about TB statistics.
• Currently, about 1 million Filipinos have active tuberculosis disease. Reports say that we
have the 3rd highest prevalence rate in the world, next to South Africa and Lesotho. More
concerning is the fact that about 70 Filipinos die every day because of TB, even though it’s
a highly curable condition.
• The World Health Organization (WHO) targets to end tuberculosis on the planet by 2030.
But in the Philippines, the cases go up annually. This makes it all the more important to
strengthen the tuberculosis treatment in the Philippines.

Tuberculosis Treatment in the Philippines

• Our country is compliant with the WHO-prescribed TB treatment, DOTS.
• DOTS stands for Directly-observed Therapy Short-course and is an effective way to “break
the cycle of transmission”. Below are the components of the program:
Patients need to receive several medications
➢ In treating an active tuberculosis disease, patients need to receive a combination of
medications. The first line drugs are rifampicin, isoniazid, pyrazinamide, and ethambutol.
Fixed dose combination (FDC) is available and the one most commonly prescribed.
➢ A person who has an active TB disease might need to take a break from work or school for
at least two weeks to receive their medications. After that period, their symptoms will
improve and the doctor may give clearance after the assessment.
➢ However, to completely clear the tuberculosis disease and infection, they need to
complete the short-course treatment for 6 months.
➢ A healthcare worker will observe when the patient takes their medicines
➢ The highlight of TB DOTS in the Philippines is this: Someone has to observe the patient
when they take their medications.
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➢ The reason why the program is “directly-observed” is because a healthcare worker needs
to witness that the patient has indeed taken the drugs. Being directly-observed by a
healthcare worker has several advantages, namely:
• It will help the patient remember to take their medications and complete their treatment.
Completing the treatment is important because not being able to do so can result in drug
resistance, which is more costly and difficult to treat.
• The healthcare worker can see if the therapy is effective.
• The healthcare worker can notice right away if the patient develops adverse drug
reactions.

TB DOTS in the Philippines is free and convenient

➢ Finally, please note that the DOTS tuberculosis treatment in the Philippines is free. The
public hospital, clinic, or health center will provide the patient with all the medications they
need.
➢ Moreover, it’s also convenient. Patients can meet the healthcare worker in the health
facility, their workplace, or any convenient location.
➢ If patients choose to be treated in a private facility, PhilHealth pays PHP 4,000 for the entire
6-month treatment. This covers diagnostic tests, consultation, and medications during the
DOTS program.

Diagnostic Tests for TB

If you suspect that you or a loved one has pulmonary TB disease, you can head straight to the
nearest health facility in your area, like a health center.
• There, the doctor will teach you how to collect 2 samples of sputum (phlegm).
• They will then check if the Mycobacterium tuberculosis is present in the sputum.
• The physician will also order a chest x-ray to diagnose TB and to see how severe the TB
disease is in the patient’s lungs.
• If positive, they may immediately introduce you to TB DOTS.

There are also two other tests for the latent TB infection: TB skin test, which is mostly for children,
and TB blood test.
• In the TB skin test, the doctor will inject a little amount of fluid (tuberculin) under the skin.
• The patient must come back after 48 or 72 hours to have the injection site checked.
• Whether you’re TB positive or negative depends on the appearance of the injection site.
• In the TB blood test, the physician will collect a sample of your blood to see if the
tuberculosis bacteria are present in the body.
• It’s worth noting that both TB skin and blood tests cannot diagnose an active TB disease.
They can only check for infection.

➢ Hence, if a TB skin test or blood test gives a positive result, the patient will need
further tests (x-ray and sputum) to see if the infection has already progressed to
disease and to rule out an active TB infection.
Key Takeaways
• Pulmonary tuberculosis is one of the major health concerns in our country, accounting to
around 70 deaths daily. The good thing is this disease is highly curable through regular and
continuous medication therapy.
• The tuberculosis treatment in the Philippines, particularly the DOTS program, ensures that
TB patients receive the correct medications they need to completely clear their disease
and infection.
 TB-DOTS | PHILIPPINES 2022

6 Common Questions about Tuberculosis

➢ Tuberculosis, commonly known as TB, is a bacterial infection that can spread

through the lymph nodes and bloodstream to any organ in your body. TB is most
often found in the lungs, lungs, as a person gets infected with TB through inhalation
of aerosol droplets containing the mycobacteria. How does tuberculosis spread?

➢ TB spreads from person to person through tiny droplets that are released into the
air through coughing or sneezing. Close household contact with an individual with
TB is the most important risk factor for the spread of TB.

➢ The bacteria can also attack any part of the body, including your brain, intestines,
and bones, glands, as it gains entry to the blood through your lungs.

➢ Some who are exposed to TB never develop symptoms because the bacteria can
live in an inactive form in the body, also known as the latent infection. But if the
immune system weakens, as is often the case in people in people with
immunosuppressive conditions such as HIV infection and AIDS, end stage kidney
disease, diabetes mellitus, and cigarette smoking.

➢ TB bacteria can become active again (the condition is called reactivation TB).
In their re-activated state, TB bacteria cause death of tissue in the organs they
infect. Reactivation TB disease can be fatal if left untreated.

Note: Whether you’re living with this condition or you want to lessen your risk, information is
key.

What are the Symptoms of Tuberculosis

➢ Aside from answering “how does tuberculosis spread?” it also helps to know how
to spot its signs.
➢ TB usually develops slowly. In majority of cases, after primary TB infection (i.e.
entry of TB into your lungs), 90 percent of individuals with intact immunity control
the spread of the bacteria and enter a latent phase.

➢ The infection doesn’t cause any symptoms, and this is known as Latent TB. The
person remains asymptomatic, but this latent disease can potentially become
active at any time. An estimated 2 billion people have latent TB and anywhere from
5 to 15 percent of these people will suffer from reactivation of TB during their
lifetime.

➢ When you display symptoms, it’s called Active TB.

Latent TB:
With this condition, you have a TB infection, but the bacteria remain in your body in an inactive
state. It causes no symptoms. Latent TB, which is also called inactive TB or TB infection, isn’t
contagious. Even then, it can turn into active TB, so treatment is important to help control the
spread of TB.

Active TB
This condition makes you sick and can spread to others. It can occur in the first few weeks after
infection with the TB bacteria, or it might occur years later.

Signs and symptoms of active TB include:

o Coughing that lasts three or more weeks
o Coughing up blood
o Chest pain, or pain with breathing or coughing
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o Unexplained weight loss

o Fatigue
o Fever -mostly no fever in the morning, but temperature rises towards the
evening, resulting in night sweats
o Loss of appetite

Tuberculosis usually affects your lungs, but it can also affect other parts of your body, such as
your spine, your kidneys or your brain.

What Should I Do If Someone I Know Has TB?

If you think you have been exposed to someone with TB disease, you are recommended to contact
your doctor or local health department to carry out a TB skin test or a special TB blood test. Don’t
forget to let your doctor know when you were in contact with the person who has the TB disease.
Also, visitors should wear N95 masks while visiting patients with known or suspected active TB

When Should I Seek Medical Care?

You should contact your doctor if you have a fever, unexplained weight loss, drenching night
sweats or a persistent cough. These are often signs of TB, but they may also be symptoms of other
medical problems. Your doctor can perform tests to help determine the cause.

How Do I Prevent TB?

Aside from knowing how does tuberculosis spread, it also helps to know what you do if you do
get infected.

To prevent TB, you should:

• Vaccinate
➢ In countries where tuberculosis is more common, infants often are vaccinated
with bacillus Calmette-Guerin (BCG) vaccine because it can prevent severe
tuberculosis in children. However, the BCG vaccine isn’t recommended for general
use because it isn’t very effective in adults. Dozens of new TB vaccines are in various
stages of development and testing.
• Avoid exposure to anyone with active TB
• Do NOT spend long periods of time with anyone who has active TB until that person has
been treated for at least two weeks.
• Use protective equipment
• If you must come in contact with someone who has active TB, it would be best to use
protective equipment such as N95 face masks and gloves. If you work in a facility that cares
for people who have untreated TB, personal protective equipment is a must.
• Facilitate treatment
• If you live with someone who has active TB, help and encourage that person to follow
treatment instructions.

How Do I Prevent Others from Getting Tuberculosis?

• If you have active TB, you need to isolate yourself, take your medications, and ensure
that others do not get infected. It generally takes a few weeks of treatment with TB
medications before you’re not contagious anymore. Follow these tips to help keep your
friends and family from getting sick:
• Follow your entire course of medication
• This is the most important step. If you stop treatment early or skip doses, TB bacteria
have a chance to develop mutations that allow them to survive the most potent TB drugs.
The resulting drug-resistant strains are much more deadly and difficult to treat.
• Stay home
• Don’t go to work or school until you are free from TB, or at least completed several
weeks of treatment. Do not sleep in a room with other people during the first few weeks
of treatment for active tuberculosis.
• Ventilate the room
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How does tuberculosis spread?

➢ Tuberculosis germs spread more easily in small, closed spaces where air doesn’t
move. If it’s not too cold outdoors, open the windows and use a fan to blow indoor
air outside.
➢ Cover your mouth and nose when coughing or sneezing
➢ Use a tissue to cover your mouth anytime you laugh, sneeze or cough. Put the
dirty tissue in a bag, seal it and throw it away.
➢ Wear a mask
➢ Wearing a surgical mask when you’re around other people during the first three
weeks of treatment may help lessen the risk of transmission.

Tuberculosis Treatment Course (DOTS Therapy): TB Drugs List and Side effects

Tuberculosis Treatment is carried out using the DOTS Therapy which stands for Directly Observed
Treatment Short course. The DOTS therapy makes use of antituberculosis drugs over a specified
period of time under observation as patients may not comply with drugs which leads to multidrug
resistant tuberculosis. The DOTS TB treatment therefore combats resistance.

Can Tuberculosis be cured completely?

Tuberculosis can be cured completely when there is compliance with drugs and when it is detected
early enough for Treatment to be commenced before any complication develops. Once there is
complication, cure for TB can be achieved but some complications may be permanent and can
only be alleviated.

Aims of Tuberculosis Treatment

1. In order to achieve cure for TB

2. To prevent death from active TB
3. To prevent complications
4. To prevent relapse of TB
5. To reduce transmission of TB to other people
6. To prevent the development of TB drug resistance, which is a major cause of
Multidrug resistant TB
Please note that active tuberculosis treatment should not be initiated with single drug as
resistance may occur.

Tuberculosis Treatment Guidelines

1. All recommended tuberculosis treatment regimen has 2 phases: the Initiation

phase or Intensive phase and Continuation Phase.
2. The initial intensive phase is aimed at killing actively growing and semi-dormant
tubercle bacilli
3. At least 2 bactericidal drugs such as Isoniazid (INH) and Rifampicin are necessary in
the initiation phase
4. Pyrazinamide given in the initial intensive phase allows the duration of treatment
to be reduced from 9 to 6 months.
5. Addition of Ethambutol is of benefit when initial drug resistance is suspected or
where the burden of organism is high.
Continuation phase aims to eliminate most residual bacilli and reduces numbers if failures and
relapse

TB Drugs List and their abbreviations

1. Rifampicin (R)
2. Isoniazid (H)
3. Ethambutol (E)
4. Pyrazinamide (Z)
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5. Streptomycin (S)
6. Capreomycin
7. Kanamycin
8. Viomycin
9. Ethionamide
10. Rifabutin
11. Ciprofloxacin
12. Ofloxacin
13. Rifapentin
14. Cycloserine

Classification of Anti tuberculosis drugs

1. First line TB drugs
2. Second line TB drugs

DOTS Standard TB Drugs Treatment Combination and Duration

In all cases of Tuberculosis, the Standard treatment is applied with addition of few drugs such as:
addition of Steroid to Genitourinary TB and Central Nervous system TB. Miliary
Tuberculosis, Pulmonary TB and other forms of Extrapulmonary TB all follow the standard
treatment outlined below.

Standard 6 months short course chemotherapy

This involves 2 months Intensive phase through the use of:

• Streptomycin or Ethambutol,
• Isoniazid,
• Rifampicin
• and Pyrazinamide
And 4 months Continuation Phase through the use of
• Isoniazid
• Rifampicin
Standard 9 months short course chemotherapy
This involves 2 months Intensive phase through the use of:
• Streptomycin or Ethambutol,
• Isoniazid,
• Rifampicin
• and Pyrazinamide
And 7 months Continuation Phase through the use of
• Isoniazid
• Rifampicin

First Line TB Drugs Dosage and their Side Effects

These are the recommended drugs used in combination as the first in the treatment of
active tuberculosis.

Isoniazid Dosage and Side Effects

Isoniazid Dosage
Daily dose of 5 mg/kg oral (maximum 300mg) or (900mg twice weekly or 600mg thrice weekly).
Isoniazid Side effects
1. It can cause drug induced Hepatitis
2. Can cause peripheral neuritis
3. Drug induced lupus
4. May cause seizures
5. Hypersensitivity with rash and fever
6. Involved in drug interactions with dilantin and disulfiram
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Rifampicin Dosage and Side effects

Rifampicin Dosage
10 mg/kg oral (maximum 600mg)
Rifampicin side effects
1. Orange body secretions
2. Flu-like syndrome
3. Drug induced hepatitis
4. Thrombocytopenia which may cause abnormal bleeding
5. Nausea, anorexia and diarrhea
6. Renal failure
7. Multiple drug interactions

Pyrazinamide Dosage and Side effects

Pyrazinamide dosage
25 to 30mg/kg orally/daily or 30-35 mg/kg weekly
Pyrazinamide Side effects
1. Hyperuricemia
2. Drug induced Hepatitis
3. Body Rash
4. Nausea and anorexia

Ethambutol Dosage and adverse effects

Ethambutol dosage
• 25mg/kg daily (orally) for initial 2months of treatment and then 15mg/kg orally for
the rest of treatment period
• Or 50 mg/kg twice weekly or 30mg/kg thrice weekly
Ethambutol Side effects
1. Optic neuritis
2. Gastrointestinal discomfort

Streptomycin Dosage and adverse effects

Streptomycin Dosage
• 15mg/kg given intravenously or intramuscularly (up to a maximum of 1.0g) daily for
5days in a week
• Or 5mg/kg (maximum 1.5g) twice weekly or thrice weekly
Streptomycin side effects
1. Ototoxicity
2. Vestibular dysfunction
3. Nephrotoxicity
4. Skin rash
5. Hypersensitivity reactions

Mechanisms of actions of Essential Antituberculosis drugs

Anti-tuberculosis drugs have 3 main properties: they have bactericidal activity, Sterilizing activity
and the ability to prevent resistance to treatment.
1. Isoniazid and Rifampicin are the most potent of the essential antituberculosis drugs
that are active against all populations Rifampicin being the most potent.
2. Pyrazinamide is most active in acidic environment
3. Streptomycin is bactericidal in nature and acts against rapidly multiplying TB bacilli
4. Ethambutol and Thiacetazone helps to prevent resistance

First line Tuberculosis Drugs

1. Rifampicin
2. Isoniazid
3. Ethambutol
4. Pyrazinamide
5. Streptomycin
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These 4 drugs for TB that are commonly used as first line TB Drugs. This means when you have
tuberculosis, these drugs are used first to treat the TB; if it becomes resistant to treatment, then
the second line TB drugs can be used.

Second Line TB Drugs list

1. Cycloserine
2. Thioamides such as Ethionamide and Prothionamide
3. Aminoglycosides: examples include Capreomycin, Viomycin and Kanamycin
4. Fluoroquinolones: examples include Ciprofloxacin and Ofloxacin
5. Other newer TB drugs include Rifabutin and Rifapentin

DOTS Plus TB management

➢ The DOTS Plus is a strategy for management of cases with multi-drug resistant
tuberculosis. It was developed by WHO and partner agencies in 1999 based on the
same principle with DOTS.

➢ The DOTS plus includes the use of sputum culture and drug susceptibility test for
diagnosis of TB and uses both first line drugs and second line drugs like
Ethionamide, Capreomycin, Thiacetacone and Fluoroqiunolones.

SOURCES:
➢ Understanding Tuberculosis – the
Basics. http://www.webmd.com/lung/understanding-tuberculosis-basics.
Accessed August 20, 2016. Tuberculosis - Symptoms and
Causes http://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-
causes/dxc-20188557. Accessed August 20, 2016. Understanding Tuberculosis –
Diagnosis and Treatment. http://www.webmd.com/lung/understanding-
tuberculosis-treatment. Accessed August 20, 2016.
➢ Written by Vincent Sales Updated Aug 29, 2020
➢ Medically reviewed by Mike Kenneth Go Doratan, MD
➢ Medications/Treatments | © 2022 Jotscroll Tuberculosis Treatment Course (DOTS
Therapy): TB Drugs List and Side effects - Jotscroll
PREPARED BY:
➢ Michael Z. Cayabyab, RN, MSN (inp.)