Clinical Practice Guidelines

1 Clinical Practice Guidelines for the Diagnosis, Treatment, Prevention and Control of Tuberculosis in Adult Filipinos2016 UPDATE Philippine Copyright 2016 Published by:Philippine Coalition Against Tuberculosis (PhilCAT)ISBN 978-971-93533-6-2 This guideline is intended for use by a broad range of healthcare professionals (private or government) including medical specialists, Clinical practitioners, academicians, administrators, policy workers, rights part of this publication may be reproduced in any form without prior joint permission from: Philippine Coalition Against Tuberculosis (PhilCAT)Philippine society for Microbiology and infectious Diseases (PSMID)Philippine College of Chest Physicians (PCCP)Citation as to source is suggested in the following format:Task Force: Clinical Practice Guidelines for the Diagnosis, Treatment, Prevention and Control of Tuberculosis in Adult Filipinos: 2016 Update (CPGTB2016).

2 Philippine Coalition Against Tuberculosis (PhilCAT), Philippine society for Microbiology and infectious Diseases (PSMID), Philippine College of Chest Physicians (PCCP)Printed in the PhilippinesParticipating Professional Medical Societies and AgenciesParticipating Professional Medical Societies and Agencies Philippine Coalition Against Tuberculosis (PhilCAT) Philippine society for Microbiology and infectious Diseases (PSMID) Philippine College of Chest Physicians (PCCP) Department of Health (DOH) American College of Chest Physicians (ACCP) Philippine Delegation Philippine Academy of Family Physicians (PAFP) Philippine College of Occupational Medicine (PCOM) Philippine College of Radiology (PCR) Philippine College of Physicians (PCP) OTHER CONTRIBUTING PROFESSIONAL MEDICAL SPECIALTY SOCIETIESH epatology society of the Philippines (HSP)Philippine Obstetrical and Gynecological society (POGS)Philippine Rheumatology Association (PRA)Philippine society of Allergy, Asthma and Immunology (PSAAI)Philippine society of Endocrinology, Diabetes and Metabolism (PSEDM)Philippine society of Medical Oncology (PSMO)Philippine society of Nephrology (PSN)THE 2016 CPG FOR TB IN ADULTS WAS DEVELOPED WITH FUNDING SUPPORT FROM:World Health Organization (WHO) PhilippinesPhilippine Coalition Against Tuberculosis (PhilCAT)Philippine society for Microbiology and infectious Diseases (PSMID)Philippine College of Chest Physicians (PCCP)andCPGTB Task Force 2016 STEERING COMMITTEE:Over-all Chair: MORTERA, Lalaine Llamido (PhilCAT)Co-Chairs.

3 BENEDICTO, Jubert P. (PCCP) SOLANTE, Rontgene M. (PSMID) VIANZON, Rosalind G. (DOH) TECHNICAL WRITING COMMITTEES:COMMITTEE ON DIAGNOSIS OF TUBERCULOSIS:Chair: CAMPOS-CAOILI, Janice (PSMID)Co-Chair: SALVANA, Edsel T. (PSMID)Members:ALCALA, Ferdinand G. (PSMID)ANTONIO, Claro Raymundo O. (PSMID)BENEDICTO, Ma. Teresa U. (PCR)COSCA, Katherine Z. (PSMID)DESTURA, Raul V. (PSMID)KWEK, Marion Priscilla A. (PSMID)LOYOLA, Aldrin B. (PCP)MACALALAD, Noel G. (DOH-NTRL)MAGHUYOP, Norman L. (PCCP)NAVARRO, Kate Leslie Ann C. (PSMID)PASAYAN, Mark Kristoffer U. (PSMID)PE ALOSA, Christine A. (PSMID)REVITA, Luz P. (PAFP)ROA, Kathryn U. (PSMID)VILLA, Ma. Lourdes A. (PSMID)ZABAT, Gelza Mae A. (PCP)ZAMPAGA, Sarah Victoria L. (PCR)CERVANTES, Krystal C. (Coordinator)COMMITTEE ON TREATMENT OF TUBERCULOSISC hair: ALEJANDRIA, Marissa M.

4 (PSMID)Co-Chair: GARCIA, Jemelyn U. (PSMID)Members:ALETA, Lara Theresa A. (PSAAI) CHUA, Mitzi Marie M. (PSMID) COLAYCO, Catherine S. (PSMID) FELICIANO, Oscar Ferdinand D. (PCCP) GREGORIO, Karen Marie R. (PSMID) ITABLE, Jill R. (PSMID) MARIANO, Maria Nicolette M. (PSMID)MONTEJO, Yvonne Bettina E. (PCCP)SALAMAT, Maria Sonia S. (PSMID)SESCON, Nerissa Isabel C. (PSMID)ABU, Cherry T. (PSMID)VILLAMOR, Maria Philina P. (PCCP)ROXAS, Evalyn A. (PSMID)ZAMORA, Rosally P. (PSMID)TAI, Don Bambino Geno S. (Technical Writer)COMMITTEE ON DRUG-RESISTANT TUBERCULOSISC hair: GONONG, Joven Roque V. (PCCP)Co-Chair: GLER, Ma. Tarcela S. (PSMID)Members:BASILIO, Ramon P. (DOH) CALAPIS, Rugaya (PMDT) DANAO Jr., Virgilio P. (PMDT) DONATO, Nerissa A. (PMDT) LOFRANCO, Vivian S. (DOH) RAYMOND, Lawrence O.

5 (PCCP) COMMITTEE ON TB-HIV & OTHER HIGH RISK Clinical GROUPSC hair: PANALIGAN, Mario M. (PSMID)Co-Chair: ROSARIO, Minette Claire O. (PSMID) UBALDE, Aven Kerr S. (PCCP)Members:COMMITTEE ON PREVENTION AND CONTROLC hairs: ESGUERRA, Pio (PCCP) MORFE, Jose Hesron (PCCP)Members:BERGANTIN, Maria Rhona G. (PSMID)DE JESUS, Arlene A. (PCCP)DELA CRUZ, Belinda S. (PCCP)DURAN, Samuel S. (DOH)SABANDO, May N. (PCCP)SANTIAGO, Mary Rosary T. (DOH)SOLANTE, Marietta B. (PMDT)TUY, Joan S. (PMDT)VILLACORTE, Christian T. (PMDT)BELIMAC, Jose Gerard B. (DOH-RITM) CO, Jennifer T. (POGS) CUA, Ian Homer Y. (HSP) DELA ROSA, Denky Shoji W. (PSMO) DE MESA, Erwin R. (POGS) DITANGCO, Rosanna A. (RITM) DIZON, Christine D. (POGS) ESTEBAN, Lorina Q. (POGS) EVANGELISTA, Antoinette L. (RITM) GABALDON, May (POGS)JIMENO, Cecilia A.

6 (PSEDM)LAGUNZAD Jr., Juan Paulo D. (PSN)LICHAUCO, Juan Javier T. (PRA)LI-YU, Julie T. (PRA)TAMBAN, Celito A. (PSEDM)TAYZON, Ma. Fe R. (PSMID) ZAMORA, Leonid D. (PRA)PELEO, Freddie G. (PCCP)SEMPIO, Earl Louis A. (PCCP)TIU, Dionisio M. (PSMID)YASON-RAMONTE, Mary Antoinette D. (PCCP)TECHNICAL WRITING COMMITTEE ADVISERSD iagnosis: BALGOS, Abundio A. (PCCP) MENDOZA, Myrna (PSMID) JURAO, Jr., Ludovico L. (PSMID)Treatment: LANSANG, Mary Ann D. (PSMID) MENDOZA-WI, Jennifer Ann (PCCP)Drug-Resistant TB: QUELAPIO, Ma. Imelda D. (PSMID) TUPASI, Thelma E. (PSMID) LEW, Woo Jin (WHO/Philippines)Vulnerable Groups: BALANAG Jr., Vincent M. (PCCP) BERBA, Regina P. (PSMID)Prevention/Control: GALVEZ, Benilda B. (PCCP) NAVAL, Sullian Sy (PCCP)COMMITTEE ON DRUG-RESISTANT TUBERCULOSISC hair: GONONG, Joven Roque V.

7 (PCCP)Co-Chair: GLER, Ma. Tarcela S. (PSMID)Members:BASILIO, Ramon P. (DOH) CALAPIS, Rugaya (PMDT) DANAO Jr., Virgilio P. (PMDT) DONATO, Nerissa A. (PMDT) LOFRANCO, Vivian S. (DOH) RAYMOND, Lawrence O. (PCCP) COMMITTEE ON TB-HIV & OTHER HIGH RISK Clinical GROUPSC hair: PANALIGAN, Mario M. (PSMID)Co-Chair: ROSARIO, Minette Claire O. (PSMID) UBALDE, Aven Kerr S. (PCCP)Members:VOTING CONSENSUS PANELALIP, Alex (PAFP)BALANAG Jr., Vincent M. (PCCP/PhilCAT)BERBA, Regina P. (PSMID)CADENA, Elizabeth V. (PCCP/PhilCAT)CHIKIAMCO-DIZON, Josephine A. (PAFP)GALVEZ, Benilda B. (PCCP)GARFIN, Anna Marie Celina G. (DOH)LAGAMAYO, Pedro Danilo J. (PCR)LANSANG, Mary Ann D. (PSMID)LAPENA, Josefina Isidro (PAFP)LEW, Woojin (WHO-Phil)MANTALA, Mariquita J. (TASC)MATEO, Marilyn O. (PCP/PCCP)MENDOZA, Myrna T. (PSMID)TASK FORCE ADVISORY GROUP MENDOZA-WI, Jennifer Ann (CHEST-Phil)MEJIA-SAMONTE, Marishiel D.

8 (PAFP)MORAL, Patrick Gerald L. (PCCP)NAVAL, Sullian Sy (PCCP)OBILLO, Ma. Consuelo M. (PCCP)RENALES, Marilou D. (PCOM)QUELAPIO, Ma. Imelda D. (PSMID)ROA Jr., Camilo C. (CHEST-Phil/PhilCAT)SAMANIEGO, Isabelita M. (PAFP)SARMIENTO, Amelia G. (PhilCAT)TUPASI, Thelma E. (PSMID)VIANZON, Rosalind G. (DOH)YU, Charles Y. (PCCP/APSR)Overall Advisers: ROA Jr., Camilo C. MONTOYA, Jaime , PCCP: MORAL, Patrick Gerald , PSMID: BAREZ, Marie Yvette , PAFP: ALIP Jr., Alex , PCOM: SANTIANO, Oscar , CHEST - Phil: MENDOZA, Cesar , PCP: LOPEZ, Mariano , PCR: CA AL, Johanna Patricia College of Chest PhysiciansADAfter dialysisADRA dverse drug reactionAFBAcid fast bacilliAKIA cute kidney injuryALTA lanine aminotransferaseARTA ntiretroviral therapyATSA merican Thoracic SocietyBCGB acille Calmette GuerinBMIBody mass indexBSCB iological safety cabinetsBTSB ritish Thoracic SocietyBUNB lood urea nitrogenCDCC enter for disease Control and Prevention (US)

9 CIConfidence intervalCKDC hronic kidney diseaseCLDC hronic liver diseaseCMVC ytomegalovirusCNSC entral nervous systemCPGC linical Practice guidelinesCPGTBC linical Practice Guidelines for TBCXRC hest x-rayDMdiabetes mellitusDOHD epartment of HealthDOTD irectly observed treatment DOTSD irectly observed treatment short course strategy DRTBDrug-resistant tuberculosis DSSMD irect sputum smear microscopyDSTdrug susceptibility testELISpotEnzyme-linked immunospotEMB or EEthambutolEPTBE xtra-pulmonary tuberculosis ETON ethambutol-related toxic optic neuropathyAbbreviationsACCPA merican College of Chest PhysiciansADAfter dialysisADRA dverse drug reactionAFBAcid fast bacilliAKIA cute kidney injuryALTA lanine aminotransferaseARTA ntiretroviral therapyATSA merican Thoracic SocietyBCGB acille Calmette GuerinBMIBody mass indexBSCB iological safety cabinetsBTSB ritish Thoracic SocietyBUNB lood urea nitrogenCDCC enter for disease Control and Prevention (US)

10 CIConfidence intervalCKDC hronic kidney diseaseCLDC hronic liver diseaseCMVC ytomegalovirusCNSC entral nervous systemCPGC linical Practice guidelinesCPGTBC linical Practice Guidelines for TBCXRC hest x-rayDMdiabetes mellitusDOHD epartment of HealthDOTD irectly observed treatment DOTSD irectly observed treatment short course strategy DRTBDrug-resistant tuberculosis DSSMD irect sputum smear microscopyDSTdrug susceptibility testELISpotEnzyme-linked immunospotEMB or EEthambutolEPTBE xtra-pulmonary tuberculosis ETON ethambutol-related toxic optic neuropathyFBSF asting blood sugarFDCF ixed Dose CombinationFLDF irst line drugsFMFluorescent MicroscopyGFRG lomerular filtration rateGIGastrointestinalGRADEG rades of Recommendations, Assessment, Development and EvaluationHBA1cHemoglobin A1c or glycosylated hemoglobinHDHemodialysisHIVH uman immunodeficiency virusHSCTH ematopoietic stem cell transplant HSPH epatology society of the PhilippinesIDSAI nfectious Diseases society of AmericaIFG impaired fasting glucoseIGRA interferon gamma release assayINH or HIsoniazidIPTI soniazid prophylaxis therapyIRISI mmune reconstitution inflammatory syndromeISTC international standards for tuberculosis careLAIL aboratory-acquired infectionLAML ipoarabinomannanLCPLung Center of the PhilippinesLEDL ight-emitting diode LFTL iver function testsLPALine probe assayLTBI latent tuberculosis infectionMDHM anila Doctors HospitalMDR-TBMulti-drug resistant tuberculosisMODSM icroscopic observation drug susceptibility MOPM anual of ProceduresMTBM ycobacterium