Anti TB therapy and hepatitis

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Author: Pediatric Oncall

Question
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.

Answer Discussion :

G

Genevieve Teoh

0

once liver enzymes have normalized, should aim to rechallenge ATT. for the minimum duration of anti TB, INH and Rifampicin should be onboard.
In our country, we put the patient on E and O until liver enzymes have normalised, then rechallenge INH to full dose over a week, then rifampicin over a week. if patient can tolerate then we aim for at least 7 months.

6 years ago

A

A R Chaudhari

0

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.

6 years ago

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Answer 1

Basically after 4 months of treatment, the type of TB bacilli that may be persisting in the organ would be semi growing organisms and dormant bacilli. The best drug to be used for semi growing organisms is rifampicin. INH acts best on fast growing organisms and thus has not much of a role here except to prevent resistance to rifampicin. Ethambutol does not act on semi growers and thus it would be necessary to shift the child back to INH and Rifampicin.