Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

Completion of Therapy
The case manager should verify completion of therapy. Completion of therapy is
essential to ensure that the patient is cured. It is also an Alaska TB Program and
Centers for Disease Control and Prevention (CDC) goal and important measurement of
the effectiveness of tuberculosis (TB) control efforts. Verification of completion of therapy
and a completed contact investigation are the responsibility of the PHN case manager.
Verifying Adequate Course of Treatment
Most cases of active TB can be successfully treated using the standard short course (six
months) of therapy. The case manager is responsible for considering the following
conditions and consulting with the Alaska TB Program to ensure that the patient has
received an adequate course of therapy.
If culture remains positive beyond two months of treatment, reasons for
persistent positive cultures should be examined and treatment
adjusted/prolonged.
For TB involving the bones or joints or tuberculous meningitis: These are
exceptions to the standard six-month course. See “Duration of Treatment” in the
“Treatment Regimens and Dosages” topic in the Treatment of Tuberculosis
Disease section 6.11.
HIV-negative, culture-negative patients: See “Duration of Treatment” in the
“Treatment Regimens and Dosages” topic in the Treatment of Tuberculosis
Disease section 6.11.
Relapse of TB following treatment for TB with pan-susceptible organisms.
Treatment may be prolonged to nine months or more. (Current drug susceptibility
testing must be performed and the regimen adjusted if resistance has
developed.) 61
Calculating Completion of Therapy
Base the completion of treatment on the number of doses of directly observed therapy
(DOT) received rather than on the chronological passage of time. Each dose should be
recorded on the DOT calendar and counted to ensure that the required number of doses
has been delivered and consumed over the course of the number of weeks of treatment.
For the total number of doses recommended for completion of regimens
using first-line drugs, refer to the “Treatment Regimens and Dosages”
topic in the Treatment of Tuberculosis Disease section 6.6.
A L A S K A T B P R O G R A M M A N U A L Case Management 10. 29
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