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Dr. Andrew Rynne

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Having lump near neck. Took treatment for AKT and Rcinex. What test should be done?

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Dr. Rakesh Karanwal

Internal Medicine Specialist

Practicing since :1980

Answered : 1357 Questions

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Posted on Fri, 6 Dec 2013 in Infections
Question: my wife had neck lump tb for past six months and she has perfectly completed treatment with AKT 4 for two months and Rcinex 450/300 for four months ,after two months of medicine she had swollen near by lump doctor taken out fluid from the swollen part .she not feel any symtoms of tb and very fine& gain up to 10 kgs but neck lump is not completely disappear but size was reduced ,swollen part also not completely cured very less fluid coming out but it may cure with in a month i need your suggestion what type of test need to ensure complete cure of tb and medicine.
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Answered by Dr. Rakesh Karanwal 36 minutes later
Brief Answer: CONTINUE treatment for a TOTAL of ONE YEAR Detailed Answer: Hi Mr. XXXXXXX Thanks for your query. I have gone through your query thoroughly. * firstly, tuberculosis of lymph nodes and bones, takes longer time to heal as compared to that of lungs or the cavity surrounding the lungs. The course is therefore required to be continued for AT LEAST, ONE YEAR (even more, in some cases). * Hence, you SHOULD CONTINUE Rcinex 450/300 for another 6 months! (If your wife's body weight is MORE THAN 45kg, TAKE RCINEX 600/300 , instead of 450/300. Alternatively, add R-cin 150mg to Rcinex 450/300). * The swelling will take around one year or more to subside. So, please be patient and do not worry. As such, oozing of fluid from the swelling is not a good sign. Stoppage of oozing will indicate efficacy of TB treatment. * Since the treatment for lymph nodes' TB has been given for only six months so far, the tests will be inconclusive. Hence, I do not recommend any diagnostic test at this stage, EXCEPT for ESR (which, if <20) will indicate that the infection is under control. The tests for CURE should be done ONLY AFTER COMPLETING TB course for at least one year. * Lastly, usually, Nodes' TB has no/minimal symptoms. Your wife being symptomfree with increase in weight by 10kg, indicates that she is showing excellent response to treatment (but not fully cured). BUT, THE TREATMENT SHOULD CONTINUE FOR TOTAL OF AT LEAST ONE YEAR. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Please revert back to me (through DIRECT QUERY, addressed to me personally) for follow-up after completing one year of treatment, along with latest condition; state of swelling/lymph node size; and, latest ESR report. Fond regards, Dr. Rakesh Karanwal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Rakesh Karanwal 32 hours later
Already you know the staus doctor,.now I have four suggestion for my wife please you advise which one is best for cure .ESR now 35 three month before it was 55.vitamin D 10.8 ng/l desirable 30-100.Remaining all test is o.k. Suggestion 1 Rifampicin 450,Isoniazid 300,Ethambutol 800,Levofloxacin 500,Streptomycin Inj/daily and put injection powder on the surface of infection Suggestion 2 Rifampicin 450,Isoniazid 300,Ethambutol 600,Clarinova 250,Benadon,D Rise powder weekly once for 6 weeks Suggestion 3 Rifampicin 600,Isoniazid 300,Ethambutol 1000,Ultra D3 daily,Benadon Suggestion 4 rifampicin 225 mg, isoniazid 150 mg, pyrazinamide 750 mg, ethambutol hydrochloride 400 mg. Levofloxacin 500.Hepatomarin,Biodec Doctor now i have the picture but i dont know how to send with this msg if you need tell me.
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Answered by Dr. Rakesh Karanwal 1 hour later
Brief Answer: Rifampicin, isoniazid, D3 and Calcium recommended Detailed Answer: Hi Mr. XXXXXXX Nice to hear back from you. Firstly, significant weight gain and having no symptoms whatsoever, of tuberculosis, point to the fact that your wife is on ideal treatment and the tubercular bacteria are sensitive to the medicines. Further, when she is showing predictable and favorable response, addition of other drugs would NOT HASTEN recovery. We should not experiment with nature. Additional drugs if given, will not have a synergistic effect, but would complicate the matters due to their side effects. It is just as- in order to grow a sapling overnight- one pours 10kg of fertilizer along with a tankful of water!! For the same reason, ESR is just an clinical indicator of the extent of improvement. So, I will again recommend that you exercise patience and do nothing which would jeopardize your wife's health. In view of the above, irrespective of what other doctors say merely "to please the patient' without bothering about the adverse effects, I- being a staunch believer in medical ethics- would strongly recommend the following treatment. Rifampicin 600mg + Isoniazid 300mg + Ultra D3 1000mcg + Calcium Carbonate tablet daily. The following precautions should be taken:- 1. Monthly Liver function and Kidney function tests; Calcium, Phosphates and vitamin D levels. 2. Rifampicin + Isoniazid should be given EMPTY STOMACH, at least 2 hours PRIOR to breakfast and to be continued for a total of 12 months from the date of initiating treatment for tuberculosis. May I submit that it is your privilege to accept or reject my recommendation. Have a nice day, Dr. Rakesh Karanwal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Rakesh Karanwal 9 hours later
Thank you for your reply doctor.I advise to my wife whatever your recommended. put Streptomycininjection powder on the surface of infection area have any side effects if no means i will advise to my wife and she already taken on XXXXXXX of D-Rise powder it contain Cholecalciferol 60000 in last week and one thing i want to inform you doctor my wife grandfather was died in last year due to tb in lung but he not taken proper medicine and always drunk based on this only one suggestion is given to my wife to Streptomycininjection /daily and doctor may thing these four(rifampicin , isoniazid , pyrazinamide , ethambutol hydrochloride ) it not working well and he suggest Streptomycininjection as a second ling drug.I thing Streptomycininjection have many side effects. sorry for again again disturbing this is very sensitive doctor because in few weeeks i planned to foreig
doctor
Answered by Dr. Rakesh Karanwal 3 hours later
Brief Answer: CONTINUE TREATMENT AS ADVISED Detailed Answer: You are always welcome, Mr. XXXXXXX * If pus is coming out of the infection area, please use an antiseptic ointment such as Puradane/Betadine/Framycin ointment. Streptomycin powder will not have any effect. BUT NOTHING IS REQUIRED TO BE APPLIED LOCALLY IF THERE IS NO PUS/FLUID COMING OUT. * I prefer Ultra D3 1000mcg which acts faster. BUT Calcium Carbonate is a must. * I am sorry to learn that her grandfather died due to TB. But that was because he did not take appropriate treatment. * The standard practice is to give 4 drugs (rifampicin, isoniazid, ethambutol and pyrazinamide) for initial 2-3 months; thereafter, if the response is good, continue with only rifampicin and isoniazid. Only if the improvement is not satisfactory, do we continue with ethambutol or pyrazinamide for another 1-2 months along with rifampicine and isoniazid. I wish you wife a speedy recovery. Fond regards, Dr. Rakesh Karanwal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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