Diagnostic Dilemma - Pediatric Oncall
Anti TB therapy and hepatitis
Author: Pediatric Oncall
A 6 years old boy was detected to have right pleural effusion with positive Mantoux test for which he was started on 4 drug antituberculous therapy {ATT}. One month later, he developed hepatitis and INH, Rifampicin and Pyrazinamide were stopped and ATT in form of Ofloxacin and Ethambutol were continued. His Chest X-Ray was normal in 2 months. After 3 months of Ofloxacin and Ethambutol, his liver enzymes normalized and he was started on INH but developed a rash and thus was stopped. By now, he had completed 4 months of ATT.
Answers of this discussion
Author :- K Jspattica on 20 June 2011.

Author :- Seema Sharma on 20 June 2011.
Answer :- HR with close monitoring of LFTs

Author :- ankit sinojia on 23 June 2011.
Answer :- should continue HR with observation. if rashes are severe or hepatitis occurs again then it should be discontinued.

Author :- Taher M Amin on 23 June 2011.
Answer :- He must complete the course

Author :- K C Tamaria on 25 June 2011.
Answer :- yes, same treatment shall be continued.

Author :- Arvind Gupta on 26 June 2011.
Answer :- should be shift on HR as early as possible

Author :- Salvatore Cazzato on 27 June 2011.
Answer :- stop

Author :- Jasbir S Chugh on 27 June 2011.
Answer :- Once LFTs are normal,Rifampicin should be restarted first at 1, 4th of the actual dose and dose should be doubled at weekly interval till the normal dose is reached. INH can also be restarted in a similar way after the Rifampicin has reached normal dose. PZA being the most hepatotoxic of the three should not be given again. LFTs must be checked every week and if they are normal, we can stop Ofloxacin as it may lead to cartilage damage in a 6 year old child if given for a long time. Ethambutol may be continued for the remaining course of therapy with monthly eye ground examination as it can cause optic atrophy.

Author :- fificash ad on 27 June 2011.
Answer :- no complete on oflaxine and ethambutol

Author :- A R Chaudhari on 28 June 2011.
Answer :- I would prefer to stop the ATT because if the child is on ATT for more than three months {which is the minimum specified time to take ATT}. And moreover the child is clinically improved. Risk of ofloxacin induced complications should always be kept in mind.

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