Previous Vaccination with Bacillus of Calmette and Guerin (BCG)

New Hampshire Tuberculosis Program Policy
Re: Directly Observed Therapy (DOT)
Approved June 6, 1997

The New Hampshire Tuberculosis (TB) Advisory Committee, in conjunction with the TB Control Program, Division of Public Health Services, adopted DOT as the standard of care for all persons diagnosed with active TB.

DOT is defined as "observation of the patient by a health care provider or other responsible person as the patient ingests TB medications".

The Centers for Disease Control and the American Thoracic Society recommend that DOT be considered for all patients as one method of ensuring adherence to a medication regime. Patients who receive DOT can be placed on a twice- or thrice-weekly treatment schedule, generally after two weeks of daily treatment.
DOT includes the use of incentives and enablers to encourage adherence. Household members should not hold responsibility for DOT.

It is recommended that patients placed on self-administered therapy receive fixed-dose combination pills (Rifater initially and Rifamate for the continuation phase). These medications must be taken on a daily dosing regime. Patients on self-administered treatment should be monitored closely for adherence to treatment.

References:
ATS, Treatment of TB and TB Infection in Adults and Children, American Journal of Respiratory Critical Care Medicine, Vol. 149, Pgs 1359-1374

CDC, Improving Patient Adherence to Tuberculosis Treatment, 1994

South Carolina Division of TB Control, Enablers and Incentives, ALA of S.C., August 1989