🫁 PulmonologyRespiratory / InfectiousStudentInternResident

Tuberculosis (drug-sensitive) — NTEP

Also known as: TB · pulmonary tuberculosis · Koch's · RNTCP · ATT

Infection by Mycobacterium tuberculosis. India's National TB Elimination Programme (NTEP) provides free diagnosis and treatment; every case must be notified.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the latest NTEP guidance before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Anyone, but risk rises with HIV, diabetes, undernutrition, smoking, silicosis, crowding and close contact with a case. Presumptive TB = cough ≥2 weeks, fever, night sweats, weight loss or haemoptysis.

Red flags — escalate / refer

Massive haemoptysis or severe breathlessness → emergency stabilisation.
Headache, neck stiffness, altered sensorium (TB meningitis) or miliary/disseminated disease → urgent referral.
Jaundice or vomiting on treatment → suspect drug-induced hepatitis: stop ATT and refer.
Visual blurring on ethambutol → stop the drug and assess.

Work-up / diagnosis

1Send an upfront molecular test (NAAT — CBNAAT/Truenat) as the first diagnostic; it confirms TB AND detects rifampicin resistance. Sputum smear microscopy and chest X-ray support diagnosis.
2Offer HIV testing and screen for diabetes in every diagnosed patient.
3Aim for universal drug-susceptibility testing (DST) to guide the regimen.
4Notify EVERY case (public or private) on Ni-kshay — it is mandatory in India.
5Assess weight (drives dosing), nutrition, contacts (for screening) and comorbidities.

Management — overview

Standard regimen for drug-sensitive pulmonary TB = 6 months: 2 months intensive phase (H, R, Z, E) + 4 months continuation phase (H, R, E), given DAILY as weight-band fixed-dose combinations (FDC).
Add pyridoxine (vitamin B6) to prevent isoniazid neuropathy.
Support adherence (DOT / digital adherence), counsel on side-effects, and provide nutritional support (Ni-kshay Poshan Yojana).
Rifampicin-resistant / MDR-TB, or extrapulmonary/paediatric complexities → refer to the programme's DR-TB pathway.
Follow up clinically and with end-of-intensive-phase and end-of-treatment sputum checks.

In-depthFull dosing & advanced protocol

Drug dosing

Intensive phase FDC — HRZE (H 75 / R 150 / Z 400 / E 275 mg)

Months 1–2, daily, by weight band

Adult dose: 25–39 kg: 2 tabs · 40–54 kg: 3 tabs · 55–69 kg: 4 tabs · ≥70 kg: 5 tabs (once daily)
Route: Oral

Caution: Hepatotoxicity (all), visual changes (ethambutol), hyperuricaemia (pyrazinamide) — counsel and monitor.

NTEPNTEP / Central TB Division, MoHFW — Technical & Operational Guidelines for TB Control in India ↗

Continuation phase FDC — HRE (H 75 / R 150 / E 275 mg)

Months 3–6, daily, same weight band

Adult dose: 25–39 kg: 2 tabs · 40–54 kg: 3 tabs · 55–69 kg: 4 tabs · ≥70 kg: 5 tabs (once daily)
Route: Oral

NTEPNTEP / Central TB Division, MoHFW — Technical & Operational Guidelines for TB Control in India ↗

Pyridoxine (vitamin B6)

Prevent isoniazid-induced peripheral neuropathy

Adult dose: 10 mg once daily alongside ATT
Route: Oral

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Beyond standard pulmonary TB

Paediatric TB uses child weight-band FDCs (H 50 / R 75 / Z 150 and H 50 / R 75) — dose by the programme's paediatric table.
Extrapulmonary TB (e.g. bone, TB meningitis) often needs a longer continuation phase; TB meningitis and pericarditis usually add corticosteroids.
Drug-resistant TB (rifampicin-resistant/MDR) uses longer, specialised regimens — always via the programme; do not improvise.

WHOWHO consolidated guidelines on tuberculosis ↗

Monitoring & co-management

Baseline and symptom-driven liver function; stop ATT for significant hepatotoxicity and re-introduce cautiously.
Monthly visual acuity/colour check while on ethambutol.
In HIV co-infection, start ATT first, then antiretrovirals early (per NACO), watching for IRIS and drug interactions (rifampicin).

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Community-Acquired PneumoniaAcute lower-respiratory infection acquired outside hospital — fever, cough, sputum and breathlessness with a new infiltrate on chest X-ray. Streptococcus pneumoniae is the commonest cause.Bronchial AsthmaChronic airway inflammation with variable, reversible airflow obstruction — wheeze, cough, breathlessness and chest tightness. Inhaled corticosteroids are the cornerstone; never treat with a reliever alone.Chronic Obstructive Pulmonary Disease (COPD)Chronic, progressive airflow limitation (not fully reversible) from noxious exposures — persistent cough, sputum and breathlessness. Smoking and biomass smoke are the key causes.

Loading…

Tuberculosis (drug-sensitive) — NTEP

Also known as: TB · pulmonary tuberculosis · Koch's · RNTCP · ATT

Infection by Mycobacterium tuberculosis. India's National TB Elimination Programme (NTEP) provides free diagnosis and treatment; every case must be notified.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the latest NTEP guidance before clinical use.

Red flags — escalate / refer

Massive haemoptysis or severe breathlessness → emergency stabilisation.

Headache, neck stiffness, altered sensorium (TB meningitis) or miliary/disseminated disease → urgent referral.

Jaundice or vomiting on treatment → suspect drug-induced hepatitis: stop ATT and refer.

Visual blurring on ethambutol → stop the drug and assess.

Work-up / diagnosis

1Send an upfront molecular test (NAAT — CBNAAT/Truenat) as the first diagnostic; it confirms TB AND detects rifampicin resistance. Sputum smear microscopy and chest X-ray support diagnosis.

2Offer HIV testing and screen for diabetes in every diagnosed patient.

3Aim for universal drug-susceptibility testing (DST) to guide the regimen.

4Notify EVERY case (public or private) on Ni-kshay — it is mandatory in India.

5Assess weight (drives dosing), nutrition, contacts (for screening) and comorbidities.

Management — overview

Standard regimen for drug-sensitive pulmonary TB = 6 months: 2 months intensive phase (H, R, Z, E) + 4 months continuation phase (H, R, E), given DAILY as weight-band fixed-dose combinations (FDC).

Add pyridoxine (vitamin B6) to prevent isoniazid neuropathy.

Support adherence (DOT / digital adherence), counsel on side-effects, and provide nutritional support (Ni-kshay Poshan Yojana).

Rifampicin-resistant / MDR-TB, or extrapulmonary/paediatric complexities → refer to the programme's DR-TB pathway.

Follow up clinically and with end-of-intensive-phase and end-of-treatment sputum checks.

Drug dosing

Intensive phase FDC — HRZE (H 75 / R 150 / Z 400 / E 275 mg)

Months 1–2, daily, by weight band

Adult dose: 25–39 kg: 2 tabs · 40–54 kg: 3 tabs · 55–69 kg: 4 tabs · ≥70 kg: 5 tabs (once daily)
Route: Oral

Caution: Hepatotoxicity (all), visual changes (ethambutol), hyperuricaemia (pyrazinamide) — counsel and monitor.

NTEPNTEP / Central TB Division, MoHFW — Technical & Operational Guidelines for TB Control in India ↗

Continuation phase FDC — HRE (H 75 / R 150 / E 275 mg)

Months 3–6, daily, same weight band

Adult dose: 25–39 kg: 2 tabs · 40–54 kg: 3 tabs · 55–69 kg: 4 tabs · ≥70 kg: 5 tabs (once daily)
Route: Oral

NTEPNTEP / Central TB Division, MoHFW — Technical & Operational Guidelines for TB Control in India ↗

Pyridoxine (vitamin B6)

Prevent isoniazid-induced peripheral neuropathy

Adult dose: 10 mg once daily alongside ATT
Route: Oral

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Beyond standard pulmonary TB

Paediatric TB uses child weight-band FDCs (H 50 / R 75 / Z 150 and H 50 / R 75) — dose by the programme's paediatric table.

Extrapulmonary TB (e.g. bone, TB meningitis) often needs a longer continuation phase; TB meningitis and pericarditis usually add corticosteroids.

Drug-resistant TB (rifampicin-resistant/MDR) uses longer, specialised regimens — always via the programme; do not improvise.

Monitoring & co-management

Baseline and symptom-driven liver function; stop ATT for significant hepatotoxicity and re-introduce cautiously.

Monthly visual acuity/colour check while on ethambutol.

In HIV co-infection, start ATT first, then antiretrovirals early (per NACO), watching for IRIS and drug interactions (rifampicin).

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Intensive phase FDC — HRZE (H 75 / R 150 / Z 400 / E 275 mg)

Continuation phase FDC — HRE (H 75 / R 150 / E 275 mg)

Pyridoxine (vitamin B6)

📈 Beyond standard pulmonary TB

📈 Monitoring & co-management

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Intensive phase FDC — HRZE (H 75 / R 150 / Z 400 / E 275 mg)

Continuation phase FDC — HRE (H 75 / R 150 / E 275 mg)

Pyridoxine (vitamin B6)

📈 Beyond standard pulmonary TB

📈 Monitoring & co-management

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Beyond standard pulmonary TB

Monitoring & co-management

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Beyond standard pulmonary TB

Monitoring & co-management

References