# Tuberculosis and NTEP for NEET PG PSM: 2HRZE/4HRE, BPaLM, MDR/Pre-XDR/XDR, TB Preventive Treatment, Ni-kshay Poshan Source: https://tracknation.in/story/tuberculosis-and-ntep-for-neet-pg-psm-2hrze-4hre-bpalm-mdr-pre-xdr-xdr-tb-preventive-treatment-ni-kshay-poshan (TrackNation β€” free UPSC notes with PYQs) > NEET PG Community Medicine: India's TB burden and targets, presumptive TB and diagnosis, the drug-sensitive regimen 2HRZE/4HRE with doses and FDC weight bands, MDR, pre-XDR and XDR definitions, the 6-month BPaLM regimen (2025 guidelines) and other DR-TB regimens, TB preventive treatment (6H, 3HP, 1HP, 4R), Ni-kshay Poshan Yojana (β‚Ή1000/month) β€” every fact from official NTEP and ICMR documents, with verified MCQs and cards. ## Start Here 🎯 **Exam priority: High-yield (Tier 1).** *TB is the national programme most often tested: regimens, doses, resistance definitions and programme schemes. Regimens change β€” 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DR-TB guidelines** and the **ICMR standard treatment workflow**, so older notes with injectable-based MDR regimens are out of date.* CBME mapping: **CM 8** (epidemiology of communicable diseases).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 β€” 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 β€” 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 | **Drug** | **Daily dose (range)** | | Isoniazid (H) | 5 mg/kg (4–6) | | Rifampicin (R) | 10 mg/kg (8–12) | | Pyrazinamide (Z) | 25 mg/kg (20–30) | | Ethambutol (E) | 15 mg/kg (12–18) | ### Adult FDC weight bands | **Weight band (adult)** | **Intensive phase: HRZE 75/150/400/275 tablets** | **Continuation phase: HRE 75/150/275 tablets** | | 25–34 kg | 2 | 2 | | 35–49 kg | 3 | 3 | | 50–64 kg | 4 | 4 | | 65–75 kg | 5 | 5 | | >75 kg | 6 | 6 | ### Paediatric FDC bands (dispersible tablets) | **Weight** | **IP: HRZ 50/75/150 + E 100** | **CP: HR 50/75 + E 100** | | 4–7 kg | 1 + 1 | 1 + 1 | | 8–11 kg | 2 + 2 | 2 + 2 | | 12–15 kg | 3 + 3 | 3 + 3 | | 16–24 kg | 4 + 4 | 4 + 4 | | 25–39 kg | Combination of paediatric and adult FDCs | Combination of paediatric and adult FDCs | ## Drug-Resistant TB: Definitions and Regimens (2025) | **Type** | **Definition (NTEP 2025)** | | RR-TB | Resistant to rifampicin | | MDR-TB | Resistant to both isoniazid and rifampicin | | Pre-XDR-TB | MDR/RR-TB + resistance to any fluoroquinolone | | XDR-TB | MDR/RR-TB + any fluoroquinolone + at least one more Group A drug (bedaquiline or linezolid) | | **Regimen** | **Drugs / duration** | **Who** | | BPaLM | Bedaquiline + Pretomanid + Linezolid + Moxifloxacin for 26 weeks (extendable to 39) | Age β‰₯ 14 with new MDR/RR-TB, meeting eligibility criteria | | Shorter oral MDR/RR-TB regimen | 9–11 months, bedaquiline-containing | Those not eligible for BPaLM who meet its criteria | | Longer oral M/XDR-TB regimen | 18–20 months | Those not eligible for shorter regimens | - 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 | **Outcome** | **Definition (NTEP)** | | Cured | Bacteriologically confirmed pulmonary TB at start; completed treatment with evidence of bacteriological response and no failure | | Treatment completed | Completed treatment, but does not meet the definition of cure or failure | | Treatment failed | Regimen had to be stopped or permanently changed (no clinical/bacteriological response, adverse reactions, new resistance) | | Died | Died before starting or during treatment | | Lost to follow-up | Did not start treatment, or treatment interrupted for one month or more consecutively | | Not evaluated | No outcome assigned | ## Preventing TB and Supporting Patients | **Regimen** | **Meaning** | | 6H | Six months of daily isoniazid | | 3HP | Three months of weekly rifapentine + isoniazid (12 doses) | | 1HP | One month of daily rifapentine + isoniazid | | 4R | Four months of daily rifampicin | - 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 **β‚Ή1,000 per month** as nutritional support for the full duration of treatment, by direct benefit transfer. The India TB Report 2024 records about β‚Ή2,781 crore paid to about 1 crore beneficiaries since the scheme began. - **Pradhan Mantri TB Mukt Bharat Abhiyaan** enrols **Ni-kshay Mitras** β€” individuals, companies and organisations β€” 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** β€” 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 β‰₯ 14 and lasts 6 months (26 weeks). - 3HP = 12 weekly doses; 1HP = one month daily. - Ni-kshay Poshan Yojana is now β‚Ή1,000 a month (not β‚Ή500). ## Rapid-Revision Cards - 2HRZE / 4HRE β€” 56 + 112 doses. - Pyrazinamide. - CNS TB, skeletal TB. - H 5, R 10, Z 25, E 15. - 25–34: 2 Β· 35–49: 3 Β· 50–64: 4 Β· 65–75: 5 Β· >75: 6. - Resistant to both H and R. - MDR/RR + any fluoroquinolone. - Pre-XDR + bedaquiline or linezolid. - Bdq + Pretomanid + Lzd + Moxi; 26 weeks (to 39); age β‰₯ 14. - Shorter oral 9–11 months; longer oral 18–20 months. - 6H, 3HP (12 weekly doses), 1HP, 4R. - β‚Ή1,000/month for whole treatment, DBT. - Detect, Treat, Prevent, Build. - 237 β†’ 199 per lakh (2015β†’2022); deaths 28 β†’ 23. - Cured needs bacteriological evidence of response; completed does not meet cure criteria. - Interrupted β‰₯ 1 month consecutively (or never started). - Upfront for all diagnosed patients; NAAT upfront for diagnosis. - 4–7: 1 Β· 8–11: 2 Β· 12–15: 3 Β· 16–24: 4. ## Sources ## Sources *Facts in this article were checked against these documents.* - Standard Treatment Workflow: Drug Sensitive-TB Treatment as per NTEP β€” ICMR / Department of Health Research, March 2022 (link) - National Guidelines for Management of Drug-Resistant TB β€” Central TB Division, MoHFW, 2025 (link) - Guidelines for Programmatic Management of TB Preventive Treatment in India β€” Central TB Division, MoHFW, 2021 - National Strategic Plan for Tuberculosis 2017–25 β€” MoHFW, 2017 - India TB Report 2024 β€” 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, βˆ’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 **Answer: (d)** β€” NTEP uses 2HRZE/4HRE: 8 weeks of four drugs, then 16 weeks of H, R and E. **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 **Answer: (d)** β€” Only pyrazinamide is stopped in the continuation phase; H, R and E continue. **Q3.** The intensive phase of DS-TB treatment consists of how many daily doses? - (a) 112 - (b) 28 - (c) 56 - (d) 84 **Answer: (c)** β€” 8 weeks = 56 doses; the continuation phase is 16 weeks = 112 doses. **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 **Answer: (b)** β€” The CP is extended up to 24 weeks for CNS TB and skeletal TB. **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 **Answer: (c)** β€” H 5, R 10, Z 25, E 15 mg/kg daily. **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 **Answer: (c)** β€” Weight bands: 25–34 kg β†’ 2, 35–49 β†’ 3, 50–64 β†’ 4, 65–75 β†’ 5, >75 β†’ 6 tablets. **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 **Answer: (b)** β€” Pre-XDR = MDR/RR-TB plus resistance to any fluoroquinolone; XDR additionally needs bedaquiline or linezolid resistance. **Q8.** Under the current definition, XDR-TB requires resistance to rifampicin (Β± isoniazid), any fluoroquinolone and - (a) pyrazinamide - (b) ethambutol - (c) bedaquiline or linezolid - (d) an injectable aminoglycoside **Answer: (c)** β€” XDR-TB: MDR/RR-TB + any fluoroquinolone + at least one more Group A drug (bedaquiline or linezolid). **Q9.** The BPaLM regimen consists of bedaquiline, pretomanid, linezolid and - (a) delamanid - (b) levofloxacin - (c) clofazimine - (d) moxifloxacin **Answer: (d)** β€” BPaLM = Bedaquiline, Pretomanid, Linezolid and Moxifloxacin, for 26 weeks (extendable to 39). **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 **Answer: (b)** β€” Eligibility starts at 14 years and above with new microbiologically confirmed MDR/RR-TB. **Q11.** The usual duration of the BPaLM regimen is - (a) 9–11 months - (b) 26 weeks - (c) 18–20 months - (d) 12 weeks **Answer: (b)** β€” BPaLM runs 26 weeks (about 6 months), extendable to 39 weeks; the shorter oral regimen is 9–11 months and the longer one 18–20 months. **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 **Answer: (b)** β€” 3HP = three months of weekly rifapentine plus isoniazid, 12 doses. **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 **Answer: (b)** β€” 1HP: one month of daily rifapentine plus isoniazid. **Q14.** Under the Ni-kshay Poshan Yojana, each TB patient receives - (a) free food rations only - (b) β‚Ή500 per month for 6 months - (c) β‚Ή1,000 per month for the full duration of treatment - (d) β‚Ή500 once **Answer: (c)** β€” All TB patients are eligible for β‚Ή1,000 per month as nutritional support for the whole treatment, by DBT. **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 **Answer: (c)** β€” The NSP is driven by the Detect–Treat–Prevent–Build approach. **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 **Answer: (c)** β€” Incidence fell from 237 per lakh (2015) to 199 per lakh (2022); mortality from 28 to 23 per lakh. **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 **Answer: (c)** β€” Cured requires bacteriologically confirmed TB at the start, completed treatment, evidence of bacteriological response and no failure. **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 **Answer: (a)** β€” Lost to follow-up: did not start treatment or treatment consecutively interrupted for one month or more. **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 **Answer: (c)** β€” The NSP made DST upfront for all diagnosed patients, along with rapid molecular tests for diagnosis. **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 **Answer: (d)** β€” Paediatric bands: 4–7 kg 1, 8–11 kg 2, 12–15 kg 3, 16–24 kg 4 tablets (plus the same number of E 100). **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) **Answer: (d)** β€” TBI is a persistent immune response to M. tuberculosis antigens with no evidence of clinically manifest disease. ### 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.