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How Long Should Rifampicin And Levofloxacin Be Continued For TB?

Posted on Mon, 13 Jul 2015

Question: Hi,

The Medicine Specialist has asked my mother to do a blood test

The report:-
Basophil-4(Normal is said as 3 or below)
ESR-30(Normal 20 and below)
Lymphocyte:- 48%
WBC-8000(normal below 11000)

others tests are normal-LFT, sugar level, etc.

What will she do? Continuw with the drugs or leave them?

Rifamcin-12 months almost over
Levofloxacin-Almost 5 months

She will complete on 22nd XXXXXXX as 1 year of anti-TB drugs intake.

Thanks and Regards,
XXXX XXXXXXX

Answered by Dr. Divakara (1 hour later)

Brief Answer:
She can stop medicines.

Detailed Answer:
HI

Greetings from Dr.Divakara.P
Thanks for posting your query.

Well she can definitely stop Rifampicin. The course for TB drugs is 6-12 months sometimes for 18 months in special case , but for Lymph node TB 12 months is very adequate.

Now coming to Levoflox she has taken only 5 months but as far as I know she has also taken 8 months of Ofloxacin also. Though Ofloxacin is not as effective as Levoflox but they both belong to same class of drugs called Fluroquinolones.

So with Ofloxacin and Levoflox combined she has taken 13 months of medication and hence she can stop Levoflox also.

Also I need to know whether the lymph nodes are still enlarged and if so I advise a FNAC of the nodes which is the best test to check whether TB has completely been cured.

Hope this information was useful to you.
Any clarifications feel free to ask.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Divakara (7 hours later)

Hi Doctor,

1) My physical examination by the Medicine specialist there is no enlargement of Lymph nodes
2) She was suffering also from TB Meningitis
3) She stopped almost all drugs(except Rifamcin and Ofloxacin) within 4.5 months of the beginning of treatment as she was suffering from retrobulbar neuritis.
4) Also why ESR and Lymphocyte(Normal mentioned is below 40%) are high?

Thanks and Regards,
XXX XXXXXXX

Answered by Dr. Divakara (5 hours later)

Brief Answer:
ESR and lymphocytes are non specific tests.

Detailed Answer:
HI

Thanks for the follow up.

No lymph nodes on examination is a good sign and she can stop the medicines. As of TB meningitis is concerned I recommend a test called CSF TB PCR just to confirm that TB meningitis is completely cured.

ESR and lymphocytes are non specific parameters, though they are elevated in TB but they raised in many conditions like Viral infections, Arthritis, etc. I don't think you need to worry about it .

In my opinion if the CSF TB PCR report is normal then she can totally stop the medicine.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Divakara (2 hours later)

Hi Doctor,

1) The doctor has recommended FNAC test but also added that it is difficult to detect TB. This is because she had to undergo 5 FNAC tests and then only TB was detected. So he told that it may not be very effective.
2) Also he told that Lumbar Puncture test may not be that successful(was carried out last year to detect TB Meningitis) as she had steroids for 3 months at the beginning constantly.
But I will surely ash him about CSF TB PCR test as you have suggested.

Thanks and Regards,
XXXX XXXXXXX

Answered by Dr. Divakara (20 hours later)

Brief Answer:
NO effect of steroids on CSF TB PCR

Detailed Answer:
HI

Steroids will not effect the outcome CSF TB PCR test and hence can be done for her.

As of FNAC test is concerned your doctor is right and hence not recommended since you said that there are no enlarged lymph nodes on clinical examination.

Hope this information was useful to you .

Regards.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar