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How Long Do Anti-tubercular Treatment For Abdominal TB Take To Be Effective?

Posted on Fri, 3 Jul 2015

Question: I am treated for gastro TB. Prescribed Pzide750(twice a day)+Combutol+R-Cinex600+Benedon. I mistakenly took Pzide only once a day for 1.5 months.After that, I visited doctor again and he asked me to continue full dose for 2 more months. So after total 3.5 months, Pzide and Combutol was stopped by doctor and asked me to continue R-Cinex600 for next 6 months. As I slipped full dose of Pzide first 1.5 months, am I on right track with TB treatment now? As I am taking antibiotic for 9 months, would it impact my immune system after I finish the dose?

Answered by Dr. Tushar Kanti Biswas (2 hours later)

Brief Answer:
Better to add moxifloxacin

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.

You are a case of extra-pulmonary tuberculosis (Gastro-intestinal TB). Duration of Anti-tubercular treatment for abdominal TB is 9 months -12 months (3 EHRZ + 6 HR in your case ).

Duration of Anti-TB treatment(ATT) is optimum in your case. However since you have taken under dose (Adult dose : 25 mg/kg/kg orally daily) of pyrazinamide (Z)750 mg once a day instead of the correct dose of 750 mg twice a day for initial 1.5 months, there are possibilities that you developed resistance to that drug. You are now on HR (INH 300 mg + Rifampicin 600 mg) for next 06 months.I would rather add Tablet Moxifloxacin (400 mg) a second-line anti-tubercular drug along with HR for next 06 months, since your pyrazinamide was suboptimal dose initially.A fluoroquinolone(Moxifloxacin) will strengthen the ATT regimen . Continue Benadon along with HR.

What is your present body weight?Regaining body weight would be a sign of recovery.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Tushar Kanti Biswas (43 minutes later)

I did not loose much weight due to TB and my detection was early as per doctor. I am 5' and 4.5" with 55 kg weight. I gained around 2 kg in last 3 months. I had pain in my stomach which was diagnosed as TB. After 1 month of medicine, i was completely relieved from symptoms (though i was taking under dose of pzide).
My doctor said, as i took underdose of pzide for 1.5months, he extended duration of pzide to 3.5 months instead of 2 months as standard practice. Do you think I should start Moxifloxacin for next 6 months? is there a way I could be sure that pzide did not completed its job?

Answered by Dr. Tushar Kanti Biswas (30 minutes later)

Brief Answer:
Anti-TB treatment(ATT) -introduction of 2nd line drug

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
In fact,there is no way now to know whether mycobacterium tuberculosis was susceptible to Pyrazinamide(PZA) during 3.5 months of treatment with that drug along with Ethambutol(E),INH(H) & RIF(R). Since there is a possibility of PZA resistance in your case,at this stage addition of fluoroquinolone(Moxifloxacin) for next 06 months would be justified.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

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Above answer was peer-reviewed by : Dr. Vinay Bhardwaj