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Suggest treatment for lymph node TB

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Posted on Tue, 16 Jun 2015
Question: My son has been diagnosed with lymph node TB. He was having swollen glands in his neck ,his MANTOUX test was positive, his AUTOMATED E.S.R( Westergren’s method) was 68 , haemoglobin was 9.2 and was running low grade (101 F) occasional fever in the evening. He is 12 and half years old and weighs 31 kg. Doctor recommended him a tab of forecox 150 (content : ethambutol Hydrocloride 275 mg, isoniazid 100 mg, pyrazinamide 500 mg, rifampicin 150 mg) empty stomach in the morning. He started taking tablet from 22nd Apr 2015. After 17 days , doctor checked him and found that he was subjectively better and his gland had subsided and his weight increased from 30.5 to 33.5 Kg. So doctor advised him to take two tablets of forecox 150 because dosage was on lower side.
After taking two tablets , my son was having fullness in his stomach for first two days then he started experiencing nausea and vomiting sensation whenever he was trying to eat. After seeing this, Doctor suggested to take one and half tab of forecox 150. But reducing the dosage didn’t help and he started having motions also and he was not eating at all. After experimenting with different quantity of dosage for few days, he is again back on one tablet. He has followed the schedule till now

22nd Apr – 8th May (17 day) : 1 tab of forecox 150
9th May – 11th May (3 days) : 2 tab of forecox 150
12th May – 16th May (5days) : 1.5 tab of forecox 150
17th May -18th May (2 days) : 1 tab of forecox 150
19th May -23rd May (5 days) : 1.5 tab of forecox 150
24th May – 26th May (3 days) : 1 tab of forecox 150

Now his condition is better but he is still not eating well. Doctor says that we will monitor his condition for a few more days by giving him only one tablet of forecox 150 . After 10 days, the dosage can be increased gradually. As of now, his body is not able to take more dosage. He has gone through few tests again on 22nd May 2015. His gland has become normal. His hemoglobin is increased from 9.5 to 10.2 and AUTOMATED E.S.R test is showing value dropping from 68 to 28. His liver test was also fine. Still we have observed that usually in the evenings his energy level reduces and he does not want to eat anything. But currently the main concerns are –
(1) His appetite has reduced and his haemoglobin is still very low
(2) His weight is dropping because he is not eating well. ( 33.5 to 30.5 kg in last 14 days)
(3)Also, we are afraid that low dosage and frequent variations in the quantity can create resistance .

Kindly let me know how we can reduce the side effect of forcox150 and whether low dosage can create any resistance in future .Also it would be of great help if you could suggest the ideal diet for his quick recovery.

Thanking you in anticipation for an early response. God bless you.

Regards
XXXX
doctor
Answered by Dr. Diptanshu Das (49 minutes later)
Brief Answer:
Please give doses as recommended for his weight

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone carefully through the details and understand your concerns. In tuberculosis, combination therapy is given in order to avoid resistance. Although a suboptimal dose will not be effective, it is unlikely to lead to resistance. The required dosage depends on the body weight. The following document should be useful to you in order to understand the dosage in children:
http://www.who.int/tb/challenges/interim_paediatric_fdc_dosing_instructions_sept09.pdf
Irrespective of the side effects, it is perhaps better to follow the prescribed dosage as per his weight. Suitable medicines may be given alongside to counter the side effects but I do not think that you should try to reduce the side effects by reducing the dose.

Antitubercular medications are frequently known to have a number of side effects. Loss of appetite is not unusual. You would have to bear with it. Nevertheless, he still has to take in a good amount of protein in order to aid the healing process for his body. There is no short cut available in this regard. Please do not worry, gradually the weight should improve. Iron supplements need to be given in order to take care of the low hemoglobin.

Hope that helps.

Regards
Dr. Diptanshu Das
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Diptanshu Das

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Practicing since :2005

Answered : 3828 Questions

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Suggest treatment for lymph node TB

Brief Answer: Please give doses as recommended for his weight Detailed Answer: Thanks for asking on HealthcareMagic. I have gone carefully through the details and understand your concerns. In tuberculosis, combination therapy is given in order to avoid resistance. Although a suboptimal dose will not be effective, it is unlikely to lead to resistance. The required dosage depends on the body weight. The following document should be useful to you in order to understand the dosage in children: http://www.who.int/tb/challenges/interim_paediatric_fdc_dosing_instructions_sept09.pdf Irrespective of the side effects, it is perhaps better to follow the prescribed dosage as per his weight. Suitable medicines may be given alongside to counter the side effects but I do not think that you should try to reduce the side effects by reducing the dose. Antitubercular medications are frequently known to have a number of side effects. Loss of appetite is not unusual. You would have to bear with it. Nevertheless, he still has to take in a good amount of protein in order to aid the healing process for his body. There is no short cut available in this regard. Please do not worry, gradually the weight should improve. Iron supplements need to be given in order to take care of the low hemoglobin. Hope that helps. Regards Dr. Diptanshu Das