Appendix 36. Drug-o-gram

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 "invalid, error, no result"

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	H	R	Z	E		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	H	R	Z	E	Lfx	Mfx	Bdq	Lzd	Cfz	Cs	Dlm	Am	Eto	PAS	Hh	Pa	Other	Date  result	Comments
28/12/2022	R	R			S	S						S						28/12/2023
09/04/2023	R	R			R	R						S						09/04/2023	New resistance FQs
08/05/2023	R	R			R	R						S						08/05/2023

 

pDST
Date   collection	H	R	Z	E	Lfx	Mfx	Bdq	Lzd	Cfz	Cs	Dlm	Am	Eto	PAS	Hh	Pa	Other	Date  result	Comments
28/12/2022	R	R	S	-	S	S	S		S			S						28/02/2023
01/03/2023	R	R	S	-	R	R	R	S	S	-	S	S	S	S	-	-		12/05/2023	Resistance FQs + Bdq
02/04/2023	R	R	S	-	R	R	R	S	S	-	S	S	S	S	-	-		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