Directly Observed Treatment, Short-course (DOTS)
Generic Name
DOTS (Directly Observed Treatment, Short-course)
Manufacturer
World Health Organization (WHO) and National Tuberculosis Programs
Country
Implemented worldwide in over 180 countries
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Description
Overview of the medicine
DOTS is the globally recommended strategy for controlling tuberculosis. It ensures that patients take the correct antituberculosis drugs in the correct dosage for the required duration, typically by direct observation of a healthcare worker or trained layperson, to maximize adherence and minimize drug resistance.
Uses & Indications
Dosage
Adults
Standard WHO-recommended anti-TB regimens, typically an intensive phase of 2 months (e.g., Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) followed by a continuation phase of 4 months (e.g., Isoniazid, Rifampicin), administered daily or thrice-weekly under direct observation.
Elderly
Dosage adjusted based on individual drug considerations and renal/hepatic function, under direct observation.
Renal_impairment
Dosage of specific anti-TB drugs (e.g., Ethambutol, Pyrazinamide, Streptomycin) must be adjusted according to renal function, under direct observation.
How to Take
Oral anti-tuberculosis drugs are administered, with each dose directly observed and recorded by a trained healthcare worker or community volunteer to ensure adherence. This can occur at a health facility, in the patient's home, or at a convenient community location.
Mechanism of Action
The primary 'mechanism' of DOTS is to ensure treatment adherence and completion by having a healthcare worker or trained observer witness each dose of medication. This prevents irregular intake, reduces the risk of drug resistance, and improves treatment outcomes for tuberculosis.
Pharmacokinetics
Onset
Not applicable to DOTS (refers to individual anti-TB drugs)
Excretion
Not applicable to DOTS (refers to individual anti-TB drugs)
Half life
Not applicable to DOTS (refers to individual anti-TB drugs)
Absorption
Not applicable to DOTS (refers to individual anti-TB drugs)
Metabolism
Not applicable to DOTS (refers to individual anti-TB drugs)
Side Effects
Contraindications
- While DOTS itself has no direct contraindications, the individual anti-TB drugs within the regimen have specific contraindications (e.g., severe liver disease for Isoniazid/Rifampicin, optic neuritis for Ethambutol). The regimen must be tailored to the patient's health status.
- Severe adverse reactions to components of the regimen
Drug Interactions
Isoniazid
Inhibits metabolism of Phenytoin, Carbamazepine, Benzodiazepines, potentially increasing their levels. Can also interact with alcohol.
Rifampicin
Potent inducer of cytochrome P450 enzymes, leading to interactions with oral contraceptives, anticoagulants (Warfarin), corticosteroids, antiretrovirals (ARTs), etc.
Storage
Anti-TB drugs should be stored according to their individual product labels, typically at room temperature, away from moisture and direct light.
Overdose
Not applicable to DOTS as a strategy. Overdose of individual anti-TB drugs requires specific management (e.g., Pyridoxine for Isoniazid overdose, gastric lavage, supportive care).
Pregnancy & Lactation
The anti-TB drugs used in DOTS are generally considered safe in pregnancy (Isoniazid, Rifampicin, Ethambutol). Pyrazinamide is generally safe. Streptomycin is contraindicated due to ototoxicity. Lactation is generally considered safe with standard first-line drugs. Consult a physician for specific advice.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Not applicable (refers to shelf life of individual anti-TB drugs)
Availability
Globally available through national tuberculosis control programs
Approval Status
WHO recommended and widely adopted global strategy
Patent Status
Not applicable (it's a public health strategy)
WHO Essential Medicine
YesClinical Trials
Extensive research and clinical trials have demonstrated the effectiveness of the DOTS strategy in improving treatment outcomes and reducing TB incidence and drug resistance globally. WHO recommendations are based on this evidence.
Lab Monitoring
- Baseline and regular monitoring of liver function tests (ALT, AST)
- Renal function tests (creatinine) for Ethambutol, Pyrazinamide dosage adjustment
- Visual acuity testing for Ethambutol
- Hearing tests for injectable agents (e.g., Streptomycin, if used in MDR-TB regimens)
Doctor Notes
- Emphasize the importance of patient education and counseling regarding the DOTS strategy.
- Ensure proper training and supervision for DOTS observers.
- Regularly monitor patients for adherence and adverse drug reactions.
- Promptly adjust regimens in case of drug resistance or severe side effects.
Patient Guidelines
- Take all medicines as prescribed and under direct observation.
- Do not miss any doses.
- Report any side effects immediately to your healthcare provider.
- Complete the entire course of treatment, even if you feel better.
- Avoid alcohol during treatment.
- Attend all scheduled follow-up appointments.
Missed Dose Advice
Missing doses is strongly discouraged as it can lead to treatment failure and drug resistance. If a dose is missed, the patient should contact their healthcare provider immediately. The observer should ensure the missed dose is taken as soon as possible and maintain the observation schedule.
Driving Precautions
Some anti-TB drugs can cause dizziness, blurred vision (e.g., Ethambutol), or other central nervous system effects. Patients should be advised to assess their response to treatment before driving or operating machinery.
Lifestyle Advice
- Maintain a healthy diet and adequate rest.
- Avoid smoking and excessive alcohol consumption.
- Practice good respiratory hygiene (e.g., covering coughs/sneezes).
- Ensure good ventilation at home.
- Inform close contacts about TB exposure and encourage screening.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.