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Is AKT4 effective in treating tuberculosis

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Posted on Wed, 11 Jun 2014
Question: TB in uterus diagnosed in my wife aged 33 years (Weight 56 kgs) based on followings:-

MT=14 MM, blockage in left fallopian tube, ESR=34. However chest xray normal. These test done during treatment of second baby since she not conceived from last 6 months. No cough, no fever and no other problem i.e. no symptoms of illness.

As per Gynaecologist advise she started AKT 4 from 18.04.2014 on split timing like rifampicin 450 mg (before breakfast), 2 (tabs) pyrazinamide 750 mg (one before lunch and one after lunch), 1 (tab) ethambutol 800 mg, isoniazid 300 mg(after dinner). Her bleeding at the time of mens from last 3 months was also not proper.

On 03.05.2014 LFT test done which was normal.

From 11.05.2014 she also started combutol 200 mg with akt4 and take all tablets with in two hours.

However another TB specialist advised that AKT4 is not sufficient for the person having weight more than 50kgs. He suggested that Rcinex 600mg (before breakfast), combutol 1000mg & macrozide 1000 mg (after breakfast, i.e. all tb tablets with in two hours) and benadone 20mg. As per him these are modern and effective tablets and AKT4 tablets banned outside XXXXXXX

Hence please advice that whether AKT4 is not sufficient and which medicines to be taken and what should be timings. Since I am worry to insufficient dose or timing change of medicines whether it becomes drug resistant or any adverse affect.

Since one month completed, can medicines or tablets changed now and any adverse effect like drug resistant TB.

Please advice elaborately and clear the things. Your early reply appreciated

Thanks & regards..
doctor
Answered by Dr. Arnab Maji (12 hours later)
Brief Answer:
AKT4 appropriate, to be taken at the same time

Detailed Answer:
Hello
Thanks for your query.
AKT4 till today is highly effective in any form of tuberculosis and it is more or less same as the regimen prescribed by revised national tuberculosis control programme be it pulmonary or extrapulmonary tuberculosis. But the tablets are to be taken at the same time rather than in split timing because tubercular bacteria are killed by the highest peak concentration which can only be achieved by giving the tablets at the same time usually either 1/2 hour before breakfast or 1-1 and 1/2 hours after the breakfast. Otherwise there is chance of emergence of drug resistant strain of tubercular bacilli which may be responsible for failure of tubercular regime.
If you want to know further you may write back to me.
If you are happy with my response kindly write a review for me.
Thank you.
Regards,
Dr Arnab Maji
MBBS, MD
Pulmonologist
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Arnab Maji (33 hours later)
Thanks for your reply. Timing for doses recommended by you that either 1/2 hour before breakfast or 1-1 and 1/2 hours after the breakfast, which is not clear to me. Whether It means all tablets of AKT4 should be taken either before breakfast or after breakfast.
Please note that now she taken AKT4 tablets as under:-
Rifampicin 450 mg at 7.00 am (empty stomach)
Rantac (gastic tablet) tablet at 7.20 am (empty stomach)
Then she take breakfast at 8.00 am
2 tabs pyrazinamide 750 mg & , 1 tab ethambutol 800 mg, isoniazid 300 mg after breakfast at 8.30 am
And as per doctor’s advise she also taken combutol 200 mg at 8.30 am
Whether this timing for tablets taken is right.
Further regarding dose as per TB doctor that Rifampicin 450 mg is not sufficient dose since as per weight 58 kgs X 10 per kg, it is suggested that Rcinex 600mg (before breakfast), combutol 1000mg & macrozide 1000 mg (after breakfast. However as I understand from your advice that AKT4 is sufficient dose even weight is 58 kgs.
Hence also clarify the AKT4 is sufficient dose for extrapulmonary tuberculosis and it can be cured with AKT4. Further whether combutol 200 mg can be continued with AKT4 as mentioned above.
How many months AKT4 tablets to be taken and afterwards how many months other tablets to be taken.
So please clarify about the dose and timings of medicines as well as duration.
Warm regards.
doctor
Answered by Dr. Arnab Maji (5 hours later)
Brief Answer:
Please go through the discussion below.

Detailed Answer:
Hello
Thanks for writing back to me.
I wanted to mean that all the four drugs of AKT4 are to be taken within a span of half an hour say for example between 8 -8.30 am preferably before breakfast or 1- 1.5 hour after the breakfast especially when there is nausea and vomiting after taking the medications in empty stomach i.e. before breakfast. In that case you also can take a pantoprazole-domperidone combination before breakfast and drugs to be taken after breakfast in order to reduce the incidence of nausea and vomiting.
The ideal dose of individual drug should be as follows -
1. Isoniazid 5 mg/kg body weight
2. Rifampicin 10 mg/kg body weight
3. Pyrazinamide 30-35 mg/kg body weight
4. Ethambutol 25 mg/kg body weight
This dose can be met up by adjusting the strength of AKT4 alone. In that case there is no need to add combutol extra. But it can be adjusted also by mixing AKT4 and combutol tablets like your treating physician.
Many a times genitourinary TB require some form of surgery in order to get optimum response. For this issue you need to consult a gynecologist.
Generally AKT4 is needed to given for initial 2 months and thereafter patient needs to be shifted to Rcinex for rest of the 4 months. But each treatment should be individualized depending upon the response to the treatment. Many a times extrapulmonary TB require more than 6 months of ATD therapy and that is to be decided by your treating doctor.
I think I have answered all of your queries.
If you want to know further you may write back to me.
If you are happy with my response kindly write a review for me.
Thank you.
Regards,
Dr Arnab Maji
MBBS, MD
Pulmonologist
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Arnab Maji (10 hours later)
Thanks for your prompt reply. Today LFT test done for my wife and SGOT=108 and SGPT=370 other are normal. When we consult the physician he advised daily one injection for 7 days and ask to stop the AKT4 for 7days and give other medicines. LFT test report and doctor's advise uploaded for your ready reference.

Please advise (1) what LFT report shows?
(2) Medication prescribed by physician is right? Whether these medicines also for TB?
(3) If AKT4 stopped for 7 days and start other medicines, whether it leads any other adverse affect or drug resistant TB.
Please reply.
Thanks & regards.

doctor
Answered by Dr. Arnab Maji (46 hours later)
Brief Answer:
pls see below

Detailed Answer:
Hello
Thanks for writing back.
Even in the absence of symptoms if there is more than 5 times elevation of normal level of SGPT which is in your case as revealed from your LFT report the diagnosis of drug induced hepatitis is stamped in the absence of pre-existing liver diseases and in that case either all the ATDs are to be stopped and restarted when the level of liver enzymes go back to normal level or non-heptotoxic ATD can be started which your treating doctor has rightly done.
The medications prescribed by your treating doctor is absolutely right and these medications are for TB.
There is no chance of adverse effects or drug resistant TB in this situation. You should have a repeat LFT test after 2 weeks and regular LFT check up until or unless SGOT and SGPT Level become normal.
If you have further queries you can ask me.
If you are happy with my response kindly write a review for me.
Thank you.
Regards,
Dr Arnab Maji
MBBS, MD
Pulmonologist
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Arnab Maji

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Is AKT4 effective in treating tuberculosis

Brief Answer: AKT4 appropriate, to be taken at the same time Detailed Answer: Hello Thanks for your query. AKT4 till today is highly effective in any form of tuberculosis and it is more or less same as the regimen prescribed by revised national tuberculosis control programme be it pulmonary or extrapulmonary tuberculosis. But the tablets are to be taken at the same time rather than in split timing because tubercular bacteria are killed by the highest peak concentration which can only be achieved by giving the tablets at the same time usually either 1/2 hour before breakfast or 1-1 and 1/2 hours after the breakfast. Otherwise there is chance of emergence of drug resistant strain of tubercular bacilli which may be responsible for failure of tubercular regime. If you want to know further you may write back to me. If you are happy with my response kindly write a review for me. Thank you. Regards, Dr Arnab Maji MBBS, MD Pulmonologist