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Is AKT4 Sufficient To Treat TB Infection For People Weighing More Than 50kgs?
Question: Hi, I was diagnosed with a latent TB infection in my endometrial biopsy tissue. My gynecologist started me on AKT4 for two months, followed by AKT3 for 4 months. I have completed the therapy for 3 months, but recently I was told that AKT4 is not sufficient for people who weigh more than 50 kgs. I weighed 52 kgs. approx. Would the dose that I have been taking be effective in eliminating the bacteria or will they develop drug resistance? My doctor recommends that I drop Ethambutol and just take Rifampicin (600 mg) and Isoniazid (300). Would increasing the Rifampicin from 450 to 600 mg be a good idea? Currently I weigh 50.5 kgs. Thanks!
Brief Answer:
detailed answer below.
Detailed Answer:
Hello and welcome to HCM,
I understand your issue.
Please do not worry so much. Your weight was just marginally more than 50 and now it is almost 50. The doses of most of the drugs are OK according to your weight save may be rifampicin which was slightly less.
Nevertheless most of the time the bacterial load in latent TB is not high. The more important issue is compliance with the doses. Since you have been taking them regularly then drug resistance should not be a problem at all.
The standard regimen for latent TB according to CDC does not need multiple drugs. Keeping this in mind you have already received adequate therapy.
So a continuation phase with just two drugs is more than enough.
I have provided the various regimens and going through them you will understand that you have received more than adequate therapy.
CDC regimens :
Drugs Duration Interval Minimum doses
Isoniazid 9 months Daily 270
Twice weekly* 76
Isoniazid 6 months Daily 180
Twice weekly* 52
Isoniazid
and Rifapentine 3 months Once weekly* 12
Rifampin 4 months Daily 120
Link to the above page: http://www.cdc.gov/tb/publications/factsheets/treatment/ltbitreatmentoptions.htm
So do not worry. Two drugs are enough. Take them and you should be fine.
Hope this satisfies your query.
Thanks for using HCM.
Feel free to ask any more questions that you may have.
Dr Madhuri Bagde
Consultant Obstetrician and Gynecologist
detailed answer below.
Detailed Answer:
Hello and welcome to HCM,
I understand your issue.
Please do not worry so much. Your weight was just marginally more than 50 and now it is almost 50. The doses of most of the drugs are OK according to your weight save may be rifampicin which was slightly less.
Nevertheless most of the time the bacterial load in latent TB is not high. The more important issue is compliance with the doses. Since you have been taking them regularly then drug resistance should not be a problem at all.
The standard regimen for latent TB according to CDC does not need multiple drugs. Keeping this in mind you have already received adequate therapy.
So a continuation phase with just two drugs is more than enough.
I have provided the various regimens and going through them you will understand that you have received more than adequate therapy.
CDC regimens :
Drugs Duration Interval Minimum doses
Isoniazid 9 months Daily 270
Twice weekly* 76
Isoniazid 6 months Daily 180
Twice weekly* 52
Isoniazid
and Rifapentine 3 months Once weekly* 12
Rifampin 4 months Daily 120
Link to the above page: http://www.cdc.gov/tb/publications/factsheets/treatment/ltbitreatmentoptions.htm
So do not worry. Two drugs are enough. Take them and you should be fine.
Hope this satisfies your query.
Thanks for using HCM.
Feel free to ask any more questions that you may have.
Dr Madhuri Bagde
Consultant Obstetrician and Gynecologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. XXXXXXX
Thank you for your prompt reply. My doctor has recommended Rifampicin (600 mg) and Isoniazid (300 mg) daily for additional 3 months. Rifampicin dose is higher than what I have been so far. My only concern is the latest blood test report showed an elevation in AST : 62 U/L (normal is 35) and ALT: 60 U/L (normal 45 U/L), indicating onset of hepatotoxicity? The bilirubin, albumin, RFT are all normal. In spite of the elevated liver enzymes, my doctor has advised to start Rifampicin (600 mg) and Isoniazid (300 mg) daily, which are both hepatotoxic drugs. I wanted a second opinion/advice on my situation. Please advice how I should proceed. I have no symptoms of TB whatsoever. During the course of infertility diagnosis, they found histopathological report positive for TB in my endometrial biopsy. However, the QPCR and the culture reports were negative. How long do I have to take the treatment and will it really improve my chances of pregnancy? I very much appreciate your time and help. Thank you!
Thank you for your prompt reply. My doctor has recommended Rifampicin (600 mg) and Isoniazid (300 mg) daily for additional 3 months. Rifampicin dose is higher than what I have been so far. My only concern is the latest blood test report showed an elevation in AST : 62 U/L (normal is 35) and ALT: 60 U/L (normal 45 U/L), indicating onset of hepatotoxicity? The bilirubin, albumin, RFT are all normal. In spite of the elevated liver enzymes, my doctor has advised to start Rifampicin (600 mg) and Isoniazid (300 mg) daily, which are both hepatotoxic drugs. I wanted a second opinion/advice on my situation. Please advice how I should proceed. I have no symptoms of TB whatsoever. During the course of infertility diagnosis, they found histopathological report positive for TB in my endometrial biopsy. However, the QPCR and the culture reports were negative. How long do I have to take the treatment and will it really improve my chances of pregnancy? I very much appreciate your time and help. Thank you!
Brief Answer:
detailed answer below.
Detailed Answer:
Hello and welcome back,
I understand your concern.
Increasing the dosage may not have a lot of effect now as the number of drugs have decreased. Also most of the anti TB drugs are hepatotoxic. So stopping two of them will help decrease liver toxicity. At levels of 60 and 62, I would advice a twice weekly regimen with weekly monitoring of enzyme levels. Also addition of liver tonics like liv 52 capsules, B complex vitamins and especially pyridoxine help in decreasing the toxicity. Intake of plenty of fruits and vegetables as well as proteins like eggs and sprouts with plenty of water helps to tide over the toxicity.
A six to 9 months course is usually sufficient for latent disease.
Now about the chances of fertility. Tuberculosis causes a lot of damage to the uterine lining as well as tubes. Culture reports are not always conclusive.
The damage does not allow the baby to implant and so pregnancy becomes difficult.
After your treatment is over, get a tubal patency test [ test to check if tubes are blocked] done. If the tubes are open and extent of damage to the endometrium is less then pregnancy is possible. However, unfortunately it is difficult to comment upon the exact chances of pregnancy once TB is detected. It has to be individualised in a trial and error manner.
I understand your situation as well as concern. Just complete your treatment schedule and then check the endometrial growth by serial sonography if it is more than 11-12 cm during ovulatory period then chances of conception are there.
So first complete your treatment and then think about future pregnancy.
Do not worry so much. First complete the therapy and then further evaluation will determine the chance pregnancy. The treatment does help in latent TB cases and women do conceive. So do not worry.
Dr Madhuri
detailed answer below.
Detailed Answer:
Hello and welcome back,
I understand your concern.
Increasing the dosage may not have a lot of effect now as the number of drugs have decreased. Also most of the anti TB drugs are hepatotoxic. So stopping two of them will help decrease liver toxicity. At levels of 60 and 62, I would advice a twice weekly regimen with weekly monitoring of enzyme levels. Also addition of liver tonics like liv 52 capsules, B complex vitamins and especially pyridoxine help in decreasing the toxicity. Intake of plenty of fruits and vegetables as well as proteins like eggs and sprouts with plenty of water helps to tide over the toxicity.
A six to 9 months course is usually sufficient for latent disease.
Now about the chances of fertility. Tuberculosis causes a lot of damage to the uterine lining as well as tubes. Culture reports are not always conclusive.
The damage does not allow the baby to implant and so pregnancy becomes difficult.
After your treatment is over, get a tubal patency test [ test to check if tubes are blocked] done. If the tubes are open and extent of damage to the endometrium is less then pregnancy is possible. However, unfortunately it is difficult to comment upon the exact chances of pregnancy once TB is detected. It has to be individualised in a trial and error manner.
I understand your situation as well as concern. Just complete your treatment schedule and then check the endometrial growth by serial sonography if it is more than 11-12 cm during ovulatory period then chances of conception are there.
So first complete your treatment and then think about future pregnancy.
Do not worry so much. First complete the therapy and then further evaluation will determine the chance pregnancy. The treatment does help in latent TB cases and women do conceive. So do not worry.
Dr Madhuri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. XXXXXXX
Thank you so much for your detailed reply. I really appreciate your time and advice. I have one more concern:
I had a right tube salpingectomy done in December 2013 to resolve a 7-week old ectopic pregnancy. Does slapingectomy affect the ovarian function? I have tracked ovulation using a transvaginal ultrasound a couple of times post-surgery and I seem to be ovulating from the ovary with the intact Fallopian tube. My menstrual cycle has been regular. No follicles were seen on the ipailateral ovary for a couple of months. Your thoughts on this will be very much appreciated. Thanks so much! XXXXXXX
Thank you so much for your detailed reply. I really appreciate your time and advice. I have one more concern:
I had a right tube salpingectomy done in December 2013 to resolve a 7-week old ectopic pregnancy. Does slapingectomy affect the ovarian function? I have tracked ovulation using a transvaginal ultrasound a couple of times post-surgery and I seem to be ovulating from the ovary with the intact Fallopian tube. My menstrual cycle has been regular. No follicles were seen on the ipailateral ovary for a couple of months. Your thoughts on this will be very much appreciated. Thanks so much! XXXXXXX
Brief Answer:
Answered below.
Detailed Answer:
Hello and welcome back,
Most of the time ovulation occurs from both ovaries alternately. Sometimes however one ovary may function more than the other and so will ovulate more frequently than the other. So this is not something that you need to worry about.
A salpingectomy does not affect ovarian function as such. Sometimes however the blood supply to the ovary may be compromised after a salpingectomy as some of the blood does come from the fallopian tube vessels. But this does not affect fertility as the opposite ovary is functioning well.
It is good that you are ovulating from the ovary where the tube is intact. This is good for future pregnancies as chances of conception are higher.
Hope this clears up the matter.
Dr Madhuri
Answered below.
Detailed Answer:
Hello and welcome back,
Most of the time ovulation occurs from both ovaries alternately. Sometimes however one ovary may function more than the other and so will ovulate more frequently than the other. So this is not something that you need to worry about.
A salpingectomy does not affect ovarian function as such. Sometimes however the blood supply to the ovary may be compromised after a salpingectomy as some of the blood does come from the fallopian tube vessels. But this does not affect fertility as the opposite ovary is functioning well.
It is good that you are ovulating from the ovary where the tube is intact. This is good for future pregnancies as chances of conception are higher.
Hope this clears up the matter.
Dr Madhuri
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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