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TUBERCULOSIS CARD

Name (surname, first name). Sex. Age (in years). M. F. Address (in full). Health Unit. Revised September MH 1022. BOTSWANA NATIONAL TUBERCULOSIS PROGRAMME. TUBERCULOSIS CARD. Default. I. INITIAL PHASE – (FDC- Fixed Dose Combinations). Reserve Drug.

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TUBERCULOSIS CARD

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  1. Name (surname, first name) Sex Age (in years) M F Address (in full) Health Unit Revised September MH 1022 BOTSWANA NATIONAL TUBERCULOSIS PROGRAMME TUBERCULOSIS CARD Default I. INITIAL PHASE – (FDC- Fixed Dose Combinations) Reserve Drug Children - HRZ(H30mg+R60mg+Z150mg) Adults - HRZE(H75mg+R150mg+Z400mg+E275mg) Streptomycin - 1gm vial Maximum Daily Dose Daily Dose Daily Dose in Tablets Weight in Kg. Weight in Kg. Daily Dose in Tablets 15mg/kg 750mg 30-39 2 ≤7 1 H – Isoniazid R – Rifampicin Z – Pyrazinamide E – EthambutolS – Streptomycin 40-54 3 8-14 2 ≥55 4 15-19 3 Note: If severe drug side-effect, use single dose regimen and indicate in the remarks field 20-24 4 25-29 5

  2. Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Adults – HR(H75mg+R150 mg) Children – HR(H30mg + R60mg) Weight in Kg. Daily Dose in Tablets Weight in Kg. Daily Dose in Tablets 30-39 2 ≤7 1 40-54 3 8-14 2 ≥55 4 15-19 3 20-24 4 25-29 5 Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month INITIAL PHASE CONTINUATION PHASE Instructions for recording drug administration: On days of supervised drug administration enter healthcare worker’s initials; On self-supervised days enter (▬); On missed treatment days enter (0)

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