TB Manual

The following recommendations for routine follow-up in standard first-line therapy are based on expert opinion for treatment of drug-susceptible pulmonary TB, and may vary from region to region. We recommend that routine follow-up be performed at least monthly to assess adherence and response to therapy, and to detect adverse events. Follow-up should be performed in-person whenever possible. Response to therapy should be gauged by clinical, radiologic, laboratory and microbiologic response. More frequent and intensive investigations may be required in some situations. The following investigations should be undertaken at start of treatment and during follow-up.

• Clinical

  • Start of treatment: Physical examination, weight, visual acuity, colour vision testing

  • Follow-up: Weight, repeat vision testing monthly while on EMB

  • Follow-up should also assess adherence, detect adverse events, assess response to therapy and discuss any barriers to successful TB care (including social and financial)

• Radiology

  • Start of treatment: chest x-ray at diagnosis (if not already done as part of diagnostic process)

  • Follow-up: chest x-rays at two months and at the end of therapy

• Laboratory

  • Start of treatment: complete blood count (CBC) with differential, alanine aminotransferase (ALT) or aspartate aminotransferase (AST), bilirubin, creatinine, HIV serology, hepatitis B virus serology, hepatitis C virus serology, hemoglobin A1C

  • Follow-up: CBC, creatinine, AST or ALT, bilirubin, all monthly

• Microbiology

  • Routine monitoring of sputum twice monthly until conversion to smear negative, then again at 2 months and one month before planned end of therapy. If sputum remains culture positive at 2 months, repeat sputum cultures should be performed monthly until culture conversion is confirmed

  • Sputum induction not required if unable to produce sputum and smear negative

  • Repeat DST if sputum culture is positive at 3 months

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