Selection is the process of establishing a limited list of essential anti-TB drugs to be procured based on the most current acceptable clinical treatment guidelines while defining specifications (see Box 3 and section 3.2.4) and deciding which drugs will be available at different levels of TB facilities. In many national TB control programmes it is difficult to carry out TB drug selection activities independently and managers depend on the information researched and established by WHO with respect to FDCs and drug dosing. In these cases the standard treatment regimens will be the same as those discussed under DOTS strategy above, that is, the treatment regimens recommended by WHO and IUATLD.
Even where there are adequate human resources and experienced personnel to develop national standard treatment guidelines for TB, it is still recommended to use FDCs following the WHO guidelines.
Box 3: Specifications for each drug should include
• Drug description, generic name or INN
• Alocal trade name, if any
• Dosage form e.g. tablet, ampoule for injection
• Strength, e.g. rifampicin 150 mg + isoniazid 75 mg
• Package presentations, quantity of basic units
Once FDC treatment regimens have been selected, the TB programme should preferably use drug formulations which are included in the national essential medicines list and are registered. In case the relevant FDCs are not on this list, or are not registered, the NTP should enter into dialogue with the drug regulatory authority and request FDCs to be put on the list and registered. The advantage of using the essential medicines concept is to enable a health system to limit other more expensive or poor quality drugs from being purchased at local treatment levels in decentralized systems.