Patient-wise Drug Boxes: Packing Instructions

Packaging of loose drugs into monthly patient-wise boxes should be done under the guidance of those in charge of drug logistics at the state and district levels.

Patient-wise drug box preparation should be done for the following Drug-resistant TB (DR-TB) regimens:

1. Shorter oral Bedaquiline-containing Multidrug-resistant/ Rifampicin-resistant TB (MDR/RR-TB) regimen
2. Longer oral Multi (M)/ Extensively Drug-resistant TB (XDR-TB) regimen
3. Isoniazid (H) mono/poly DR-TB regimen

Packaging Instructions

Patient-wise drug boxes are prepared as per the type of DR-TB regimen and weight bands. One monthly pouch of the capsule Cycloserine (Cs) and tablet Ethambutol (E) each, should be made from a plastic bag with a zip lock facility in which 1 gm pouch of silica gel desiccant should be kept.

In each Type A box, one pouch of silica gel desiccant of 4 gm weight should also be kept.

Labels for the boxes should be developed with the following information (Figures 2 and 3):

• Item-wise name of drugs with a quantity of each drug in the box
• Batch number and Date of Expiry (DOE) of the individual drugs
• DOE of boxes, with expiry date of the drug having the shortest expiry date
• Date of issue of the box from the State Drug Store (SDS)
• Serial number of the box
• Storage instructions on the box for ensuring adequate precautions in storage of the drugs, especially at the treatment supporter level. Some suggested messages are:
  • “Store in a cool and dark place, preferably in a clean cupboard”
  • “Do not expose to direct sunlight”
  • “Keep away from children/unauthorized persons” 
  • “Box to be closed properly every time after the withdrawal of drugs”.

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Figure 3: Prototype of a Label (Type A box for shorter DR-TB regimen for the weight band - 46 to 70 kg)

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• Standard Operating Procedure Manual - Procurement & Supply Chain Management, MOHFW, GOI.

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