Diagnostic Dilemma

Anti TB therapy and hepatitis

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.

Should be shifted to HR or should Ofloxacin and Ethambutol be used to complete treatment.
Expert Opinion :
The combination regimens used to treat active disease aim to eliminate actively replicating and dormant or near-dormant mycobacteria using a combination of drugs with different actions whilst preventing the emergence of drug-resistant organisms, and all being achieved with a minimum of toxicity.

Does anyone want to comment on action of Ethambutol and Ofloxacin on dormant or active bacilli_?
Answer Discussion :
Genevieve Teoh
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.

13 years ago
A R Chaudhari
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.
13 years ago

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