Table 10.1 - Routine patient monitoring
Assessment by a clinician
During intensive phase: every day during the first weeks if hospitalized and at least every week if treated as outpatient, until the treatment is well tolerated. Once stable, the patient is seen once or twice monthly.
During continuation phase: monthly assessment unless there is a medical necessity to see the patient more often.
The DOT supporter sees the patient daily and signals any concerns to the clinician.
Treatment adherence and tolerance
Daily at every DOT encounters by the DOT supporter.
Sputum smear and cultures
Monthly until the end of treatment.
At baseline and then monthly.
At baseline and for any positive culture during treatment.
At baseline and then every three to six months.
Serum creatinine Serum potassium (K+)
At baseline, then twice a month for the first two months, then monthly while receiving an injectable agent. Every one to three weeks in HIV-infected patients, diabetics throughout the course of the injectable agent.
Thyroid stimulating hormone (TSH)
Every six months if receiving Eto/Pto and/or PAS (every three months in HIV positive patients) and whenever signs/symptoms of hypothyroidism are present. TSH is sufficient for screening for hypothyroidism and it is not necessary to measure hormone thyroid levels.
Liver serum enzymes
At baseline then monthly during the intensive phase. Every 3 months thereafter. Monthly monitoring for HIV-infected.
Monthly for patients taking Bdq.
At baseline then repeat when clinically indicated or every 6 months in high HIV prevalence settings.
At baseline for women of childbearing age, and repeat if indicated.
Haemoglobin White blood count
If on Lzd, weekly during the first month, then monthly or as needed based on symptoms; there is little clinical experience with prolonged use of Lzd.
Baseline audiogram, then monthly during intensive phase (and whenever clinically indicated). Ask patient about changes in hearing at every clinic visit and evaluate their ability to participate in normal conversation.
For patients on long-term E or Lzd, use the Ishihara test (test for changes in the vision of colour). Perform at baseline as a certain percentage of the population has colour blindness. Then monthly in patients taking Lzd.
At baseline by trained personnel in the skills of psycho-social management, during treatment and repeat as indicated. Refer to psychiatrist when indicated.
Patients taking Bdq: at baseline then, after 2 weeks then, monthly.