Treatment Decisions

• If a patient still has a positive sputum smear at the end of the initial phase, it may indicate one of the following:
  • The initial phase of treatment was poorly supervised and drugs were not taken correctly
  • There is a slow rate of progress with sputum conversion due to, for example, widespread destruction of lung tissue and an initial heavy bacillary load, or a problem with drug absorption
  • There may be a laboratory error
  • The patient may have drug-resistant TB


• Patients with positive smear results at the end of the initial phase should receive an additional month of initial-phase drugs.


• Where treatment for MDR-TB is available, request Xpert MTB/RIF and DST and monitor clinical evolution closely.