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.
Expert Opinion :
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.