Appendix 36. Drug-o-gram

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    Update: October 2023

     

    36.1 Filling instructions  

    The drug-o-gram is filled in until the end of treatment. If necessary, add rows to the sections or use several drug-o-gram sheets. 

    Section TREATMENT  

    Each time a drug is prescribed, a dose is changed, or a drug is stopped, note the date (first column) and then in the corresponding row:

    • initial dose in mg (except PAS that is prescribed in g)
    • new dose (if dose changed)
    • a cross (X) if drug stopped

    Section MONITORING  

    Each time sputum is collected for microscopy and culture/pDST, note the date (first column), then the result in the corresponding row:

    • for microscopy: neg; scanty; 1+; 2+; 3+
    • for culture: pos; neg; cont (for "contaminated")

    Note the date of results (last column).   

    Section RMT and section pDST 

    Each time sputum is collected for a DST, note the date (first column), then the result for each drug tested in the corresponding row:

    • R for "resistance"
    • S for "susceptibility"
    • NR for "no result, invalid, error".

    Note the date of results (last column). 

    Chest x-ray (CXR)

    Each time CXR is performed, note the date and:

    • I for "initial"
    • IMP for "improvement"
    • NC for "no change"
    • D for "deterioration"

    Adherence rate (AR)

    Note the date and percentage (%), see Appendix 22

     

    Note: for dates, use dd/mm/yyyy format.

    36.2 Example

    This example is not a treatment protocol, but a fictive scenario to explain how to fill in the drug-o-gram.

    A period of a few months is shown as an example, but the drug-o-gram should be updated until the end of treatment.

     

    • 28/12/2022 Diagnosis of MDR-TB by Xpert assay. Sputum specimen sent for culture and pDST (n°1). CXR n°1.
    • 29/12/2022 Start of treatment (BPaLM regimen).
    • 15/01/2023 Continuation of BPaLM with reduction of Bdq to 3 times a week (Monday, Wednesday, Friday) as per standard protocol.
    • 31/01/2023 Culture n°1 result (positive).
    • 28/02/2023 pDST n°1 result (confirmation of MDR-TB; sensitivity to other drugs tested).
    • 01/03/2023 New specimen sent for culture and pDST n°2 (monthly bacteriological follow-up).
    • 02/04/2023 New specimen sent for culture and pDST n°3 (monthly bacteriological follow-up).
    • 09/04/2023 Culture n°2 result (positive). New Xpert assay (emergence of FQ resistance). Request for full pDST on culture n°2 (and n°3 given that specimen for culture n°3 has already been sent).
    • 10/04/2023 BPaLM regimen discontinued (treatment failure). Start of individualised long regimen. Pending results of pDST n°2, continuation of Bdq (used but not counted as probably effective drug).
    • 12/05/2023 pDST n°2 result (FQ resistance confirmed; emergence of Bdq resistance). Discontinuation of Bdq and reintroduction of Lzd 300 mg daily as per standard protocol.
    • 04/06/2023 pDST n°3 result (confirmation of resistance to FQ and Bdq). Continuation of treatment. CXR n°2.

    Etc.

     

    TREATMENT MONITORING

    Date 

    Lfx 

    Mfx 

    Bdq 

    Lzd 

    Cfz 

    Cs 

    Dlm 

    Am 

    Eto 

    PAS 

    Hh 

    Pa 

    Other 

    Date 

    collection 

    AFB 

    Culture 

    Date 

    result 

    29/12/2022 

      

      

      

     

      

      

    400 

    400 

    600 

      

      

      

      

      

      

      

    200 

      

    28/12/2022 

    3+ 

    pos 

    Culture 31/01/2023 

    15/01/2023 

      

      

      

     

      

      

    400 

    200 MWF 

    600 

      

      

      

      

      

      

      

    200 

      

    31/01/2023 

    2+ 

    neg 

      

      

      

      

      

     

      

      

    400 

    200 

    MWF 

    600 

      

      

      

      

      

      

      

    200 

      

    01/03/2023 

    neg 

    pos 

    Culture 09/04/2023  

    pDST 12/05/2023 

      

      

      

      

     

      

      

    400 

    200 

    MWF 

    600 

      

      

      

      

      

      

      

    200 

      

    02/04/2023 

    neg 

    pos 

    Culture 08/05/23 

    pDST 04/06/2023 

    10/04/2023 

      

      

      

     

      

      

    X

    200 

    MWF 

    X

    100 

    750 

    200 

      

    750 

    8 g 

      

    X

      

     

     

     

     

    12/05/2023 

      

      

      

     

      

      

      

    X

    300 

    100 

    750 

    200 

      

    750 

    8 g 

      

      

      

    04/05/2023 

    1+ 

    neg 

    Culture 04/06/2023 

      

      

      

      

     

      

      

      

      

    300 

    100 

    750 

    200 

      

    750 

    8 g 

      

      

      

    03/06/2023 

    scanty 

    neg 

      

     

    RMT

    Date  

    collection 

    Lfx 

    Mfx 

    Bdq 

    Lzd 

    Cfz 

    Cs 

    Dlm 

    Am 

    Eto 

    PAS 

    Hh 

    Pa 

    Other 

    Date 

    result 

    Comments    

    28/12/2022 

     

     

     

     

     

     

     

     

     

     

     

     

    28/12/2023 

     

    09/04/2023 

     

     

     

     

     

     

     

     

     

     

     

     

    09/04/2023 

    New resistance FQs 

    08/05/2023 

     

     

     

     

     

     

     

     

     

     

     

     

    08/05/2023 

     

     

    pDST

    Date  

    collection 

    Lfx 

    Mfx 

    Bdq 

    Lzd 

    Cfz 

    Cs 

    Dlm 

    Am 

    Eto 

    PAS 

    Hh 

    Pa 

    Other 

    Date 

    result 

    Comments 

    28/12/2022 

     

     

     

     

     

     

     

     

    28/02/2023 

     

    01/03/2023 

     

    12/05/2023 

    Resistance FQs + Bdq 

    02/04/2023 

     

    04/06/2023 

     

     

    Date

    28/12/2022 15/01/2023  01/02/2023  01/03/2023 10/04/2023 12/05/2023  04/06/2023 dd/mm/yyyy dd/mm/yyyy dd/mm/yyyy

    Weight (kg)

    50.2 49.8 49.3 49 47.2 48 48.4      

    CXR

    I           NC      

    AR (%)

        90 90 85 100 90      

     

    36.3 Templates 

     

    Drug-o-gram.pdf

    Drug-o-gram.docx