Tuberculosis and NTEP for NEET PG PSM: 2HRZE/4HRE, BPaLM, MDR/Pre-XDR/XDR, TB Preventive Treatment, Ni-kshay Poshan

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🎯 Exam priority: High-yield (Tier 1). TB is the national programme most often tested: regimens, doses, resistance definitions and programme schemes. Regimens change — this article follows the 2025 national DR-TB guidelines and the ICMR standard treatment workflow, so older notes with injectable-based MDR regimens are out of date.

CBME mapping: CM 8 (epidemiology of communicable diseases).

Burden, Targets and Strategy

• The National Strategic Plan 2017–25 set the goal of TB elimination by 2025, organised as Detect – Treat – Prevent – Build.

• The India TB Report 2024 estimates incidence fell from 237 per lakh population in 2015 to 199 per lakh in 2022, and TB mortality from 28 to 23 per lakh over the same period.

• The programme is now called the National TB Elimination Programme (NTEP), with all patients recorded on the Ni-kshay portal.

Diagnosis and Key Definitions

• Presumptive TB: a person with any symptom or sign, or a chest X-ray abnormality, suggestive of TB.

• Microbiologically confirmed vs clinically diagnosed TB depends on whether the organism is demonstrated (smear, NAAT, culture).

• TB infection (TBI): a persistent immune response to TB antigens with no clinically manifest disease — the target of preventive treatment.

Diagnosis Under NTEP: Rapid Molecular Tests Up Front

• The NSP shifted diagnosis to rapid molecular tests (NAAT) up front for presumptive TB, with drug-susceptibility testing offered to every diagnosed patient so that rifampicin resistance is found at the start, not after failure.

• Molecular tests (CBNAAT and line probe assay) were introduced from 2009 and scaled up from 2012.

• A patient is microbiologically confirmed when the organism is shown by smear, NAAT or culture; otherwise the diagnosis is clinical, based on symptoms, X-ray and clinical judgement.

Treating Drug-Sensitive TB: 2HRZE / 4HRE

• Intensive phase: 8 weeks (56 doses) of H, R, Z, E daily. Continuation phase: 16 weeks (112 doses) of H, R, E — only pyrazinamide is stopped.

• Extend the continuation phase to 24 weeks for CNS TB and skeletal TB; extend case by case in disseminated TB or slow response.

• Treatment is with daily fixed-dose combinations by weight band, given under supervision.

Doses

Adult FDC weight bands

Paediatric FDC bands (dispersible tablets)

Drug-Resistant TB: Definitions and Regimens (2025)

• The 2025 guidelines also brought bedaquiline and delamanid to all age groups and replaced ethionamide with linezolid in the 9–11-month shorter oral regimen.

• BPaLM doses: bedaquiline 400 mg daily for 2 weeks then 200 mg three times a week; pretomanid 200 mg daily; linezolid 600 mg daily; moxifloxacin 400 mg daily.

Treatment Outcomes

Preventing TB and Supporting Patients

• TB preventive treatment is offered to household contacts, people living with HIV and other high-risk groups after active TB has been ruled out.

• Ni-kshay Poshan Yojana: every TB patient gets ₹1,000 per month as nutritional support for the full duration of treatment, by direct benefit transfer. The India TB Report 2024 records about ₹2,781 crore paid to about 1 crore beneficiaries since the scheme began.

• Pradhan Mantri TB Mukt Bharat Abhiyaan enrols Ni-kshay Mitras — individuals, companies and organisations — who give nutrition baskets and other support to people on treatment.

• A national expert group has recommended adult BCG vaccination for vulnerable groups; it is being introduced in a research/implementation mode.

Traps the Examiner Sets

• Drug-sensitive TB is 6 months: 2HRZE + 4HRE — ethambutol continues in the CP; only Z stops.

• Pre-XDR = MDR + fluoroquinolone; XDR additionally needs bedaquiline or linezolid resistance (the older injectable-based definition is obsolete).

• BPaLM is for age ≥ 14 and lasts 6 months (26 weeks).

• 3HP = 12 weekly doses; 1HP = one month daily.

• Ni-kshay Poshan Yojana is now ₹1,000 a month (not ₹500).

Rapid-Revision Cards

• DS-TB regimen

  2HRZE / 4HRE — 56 + 112 doses.

• Drug stopped after IP

  Pyrazinamide.

• Extend CP to 24 weeks for

  CNS TB, skeletal TB.

• Doses (mg/kg)

  H 5, R 10, Z 25, E 15.

• Adult FDC bands (tablets)

  25–34: 2 · 35–49: 3 · 50–64: 4 · 65–75: 5 · >75: 6.

• MDR-TB

  Resistant to both H and R.

• Pre-XDR-TB

  MDR/RR + any fluoroquinolone.

• XDR-TB

  Pre-XDR + bedaquiline or linezolid.

• BPaLM

  Bdq + Pretomanid + Lzd + Moxi; 26 weeks (to 39); age ≥ 14.

• Other DR-TB regimens

  Shorter oral 9–11 months; longer oral 18–20 months.

• TPT regimens

  6H, 3HP (12 weekly doses), 1HP, 4R.

• Ni-kshay Poshan Yojana

  ₹1,000/month for whole treatment, DBT.

• NSP 2017–25 pillars

  Detect, Treat, Prevent, Build.

• Incidence trend (India TB Report 2024)

  237 → 199 per lakh (2015→2022); deaths 28 → 23.

• Cured vs treatment completed

  Cured needs bacteriological evidence of response; completed does not meet cure criteria.

• Lost to follow-up

  Interrupted ≥ 1 month consecutively (or never started).

• DST under NTEP

  Upfront for all diagnosed patients; NAAT upfront for diagnosis.

• Paediatric FDC bands

  4–7: 1 · 8–11: 2 · 12–15: 3 · 16–24: 4.

Sources

Sources

Facts in this article were checked against these documents.

• Standard Treatment Workflow: Drug Sensitive-TB Treatment as per NTEP — ICMR / Department of Health Research, March 2022 (link)

• National Guidelines for Management of Drug-Resistant TB — Central TB Division, MoHFW, 2025 (link)

• Guidelines for Programmatic Management of TB Preventive Treatment in India — Central TB Division, MoHFW, 2021

• National Strategic Plan for Tuberculosis 2017–25 — MoHFW, 2017

• India TB Report 2024 — Central TB Division, MoHFW, 2024

Test Yourself: Practice Questions

Seventeen questions in NEET PG style.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. The regimen for a new drug-sensitive pulmonary TB patient under NTEP is

• (a) 2HRZES / 1HRZE / 5HRE

• (b) 2HRZE / 4HR

• (c) 6HRZE

• (d) 2HRZE / 4HRE

Q2. Which drug is stopped at the end of the intensive phase of drug-sensitive TB treatment?

• (a) Rifampicin

• (b) Ethambutol

• (c) Isoniazid

• (d) Pyrazinamide

Q3. The intensive phase of DS-TB treatment consists of how many daily doses?

• (a) 112

• (b) 28

• (c) 56

• (d) 84

Q4. In which form of TB should the continuation phase be extended to 24 weeks?

• (a) Smear-positive pulmonary TB

• (b) Tuberculous meningitis (CNS TB)

• (c) Lymph-node TB

• (d) Pleural effusion

Q5. The recommended daily dose of rifampicin in the NTEP regimen is

• (a) 25 mg/kg

• (b) 5 mg/kg

• (c) 10 mg/kg

• (d) 15 mg/kg

Q6. An adult weighing 52 kg receives how many HRZE fixed-dose tablets daily in the intensive phase?

• (a) 5

• (b) 3

• (c) 4

• (d) 2

Q7. TB resistant to isoniazid and rifampicin and also to levofloxacin, but not to bedaquiline or linezolid, is

• (a) MDR-TB only

• (b) pre-XDR-TB

• (c) poly-drug-resistant TB

• (d) XDR-TB

Q8. Under the current definition, XDR-TB requires resistance to rifampicin (± isoniazid), any fluoroquinolone and

• (a) pyrazinamide

• (b) ethambutol

• (c) bedaquiline or linezolid

• (d) an injectable aminoglycoside

Q9. The BPaLM regimen consists of bedaquiline, pretomanid, linezolid and

• (a) delamanid

• (b) levofloxacin

• (c) clofazimine

• (d) moxifloxacin

Q10. The minimum age for the BPaLM regimen in India's 2025 guidelines is

• (a) No age limit

• (b) 14 years

• (c) 18 years

• (d) 6 years

Q11. The usual duration of the BPaLM regimen is

• (a) 9–11 months

• (b) 26 weeks

• (c) 18–20 months

• (d) 12 weeks

Q12. The TB preventive regimen '3HP' means

• (a) isoniazid + pyrazinamide for 3 months

• (b) weekly isoniazid + rifapentine for 3 months (12 doses)

• (c) rifampicin for 3 months

• (d) daily isoniazid for 3 months

Q13. '1HP' for TB preventive treatment is

• (a) one month of weekly isoniazid

• (b) one month of daily rifapentine plus isoniazid

• (c) one month of rifampicin

• (d) one dose of rifapentine

Q14. Under the Ni-kshay Poshan Yojana, each TB patient receives

• (a) free food rations only

• (b) ₹500 per month for 6 months

• (c) ₹1,000 per month for the full duration of treatment

• (d) ₹500 once

Q15. The four pillars of India's National Strategic Plan for TB 2017–25 are

• (a) Prevent, Promote, Protect, Provide

• (b) Test, Track, Treat, Trace

• (c) Detect, Treat, Prevent, Build

• (d) Screen, Diagnose, Treat, Rehabilitate

Q16. According to the India TB Report 2024, TB incidence in India between 2015 and 2022 fell from 237 to

• (a) 150 per lakh population

• (b) 100 per lakh population

• (c) 199 per lakh population

• (d) 220 per lakh population

Q17. A smear-positive pulmonary TB patient completes treatment with evidence of bacteriological response and no failure. The outcome is

• (a) lost to follow-up

• (b) treatment completed

• (c) cured

• (d) treatment success not evaluated

Q18. A patient whose treatment is interrupted for one month or more consecutively is recorded as

• (a) lost to follow-up

• (b) treatment failed

• (c) not evaluated

• (d) died

Q19. Under NTEP, drug-susceptibility testing is offered

• (a) only to retreatment cases

• (b) only after treatment failure

• (c) upfront to all diagnosed TB patients

• (d) only to HIV-positive patients

Q20. A child weighing 10 kg with drug-sensitive TB receives how many dispersible HRZ (50/75/150) tablets daily in the intensive phase?

• (a) 4

• (b) 3

• (c) 1

• (d) 2

Q21. A person with a persistent immune response to TB antigens but no clinical disease has

• (a) presumptive TB

• (b) MDR-TB

• (c) clinically diagnosed TB

• (d) TB infection (TBI)

Active Recall

From memory: write the drug-sensitive TB regimen with doses per kg and the FDC weight bands; define MDR, pre-XDR and XDR TB; list the BPaLM drugs, duration and age limit; name the four TPT regimens; and state the Ni-kshay Poshan amount and the NSP pillars.