National Tuberculosis Management Guidelines 2019

  • This guideline is to provide basic information about TB and its management to all health workers in Nepal. Early detection, appropriate diagnosis and timely treatment of TB result in good treatment outcomes. Health workers need to be equipped with the right information on the diagnosis and treatment of TB. Poor management of TB results in death and creates drug resistant (DR) TB which is very hard and costly to treat resulting in often poorer outcomes.


    All health workers in Nepal regardless of their involvement in TB services should be aware of TB, its transmission and prevention and its diagnosis and management. Health workers managing TB patients need proper guidance in diagnosis and treatment of TB and it is for this purpose that this guideline is produced. In developing this guideline, the National TB Program takes into consideration the emerging problems of TB/HIV and DR TB as well as other revisions including Latent TB infection made to TB management by World Health Organization.

    This guideline is therefore, an update from the 2012 General Manual (Third Edition) and the following are the major changes to TB management for Nepal:

    • Only 2 sputum samples required for initial diagnosis of TB.
    • Same-day diagnosis of TB by Microscopy (2 samples same day-1 hour apart)
    • Only 1 sputum sample required for follow up examination.
    • Even new presumptive TB cases should have access to GeneXpert diagnosis wherever it is possible
    • Treatment is not extended at the end of the intensive phase, even though the sputum follow up examination result remains positive at the end of two months, continuation phase is commenced regardless of whether the sputum is positive or not.
    • Streptomycin containing Category II regimen for re treatment cases will No Longer be used in Nepal

    New definitions

    • TB suspect is changed to Presumptive TB
      • Previously treated patients’ definitions have been changed and are based on the
        outcome of their most recent course of treatment and are independent of bacteriological
        confirmation or site of disease.
      • The treatment regimen for re-treatment TB cases has been removed. All previously treated
        TB patients will receive new treatment regimen and will be screened for drug resistant TB.
      • Recording and reporting forms have been edited to suit new definitions and change in
        the treatment regimen

    This Guideline Compile following topics :
    1. INTRODUCTION AND INFORMATION ON THE NATIONAL TB PROGRAM 1
    2. BACKGROUND ON TUBERCULOSIS BURDEN 9
    3. GENERAL INFORMATION ABOUT TUBERCULOSIS 11
    4. TUBERCULOSIS CLASSIFICATION AND DEFINITIONS 15
    5. TUBERCULOSIS CASE DETECTION AND DIAGNOSIS 18
    6. TREATMENT OF TUBERCULOSIS 33
    7. DIAGNOSIS AND TREATMENT OF TUBERCULOSIS IN CHILDREN 52
    8. DRUG RESISTANT /MDR TB MANAGEMENT 75
    9. TB INFECTION CONTROL 78
    10. TUBERCULOSIS AND HIV 83
    11. TUBERCULOSIS AND TOBACCO 89
    12. TUBERCULOSIS AND DIABETES 95
    13. MANAGEMENT ASPECTS OF TB CONTROL PROGRAM 99
    14 MONITORING AND EVALUATION FOR TB CONTROL PROGRAM 101
    ANNEXURES
    Annex 1a: Procedure for obtaining clinical samples for bacteriological examination 108
    Annex 1b: Job Aid for gastric aspiration 112
    Annex 2: Recommended treatment regimens and dosages use of fixed dosed
    combined (FDC) drugs 113
    Annex 3a: Guidance for dosing of INH preventive therapy 114
    Annex 3b: Recommended Anti -TB drug dosages 114
    Annex 4: Flow chart for management of bacteriologically confirmed cases 115
    Annex 5: Triple-layer packaging 116
    Annex 6: Recording and reporting forms 117

    To Read & Download Full Guideline 2019 Click Here