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Posted on Fri, 3 May 2019

Question: Welcome to 'Ask a Doctor'. Please type your question here...mother was not able to get up on her own and had severe pain in her back and lower legs for the past one year. Diagnosed with spinal Tb in XXXXXXX 2019. Been on ATT since then (INH, ethambutol, pyrazinamide, rifampicin). After two months of first line ATT- she has started getting up on her own and the pain is minimal to none. After two months, the doctor stopped INH- within days she developed swelling in one of her legs. All the tests done for swelling were negative. We consulted another doctor- he said that INH should not have been stopped and asked to continue INH. However, the initial treating orthopaedic and spine surgeon- asked to discontinue INH and increased the dose other drugs (pyrazinamide, ethambutol, rifampicin). Now we are confused- who to listen as we have two doctors with differnt treatment approaches-- should discontinue INH after two months and continue taking other drugs with increased dose or continue taking INH.

Answered by Dr. Sudhir Kumar (1 hour later)

Brief Answer:
INH should be continued for 6 months.

Detailed Answer:
Hi,

Thank you for posting your query.

We follow the WHO (World Health Organization) guidelines.

Spinal tuberculosis falls under category-1 of the WHO treatment category. The category-1 antituberculosis treatment regimen is divided into two phases: an intensive (initial) phase and a continuation phase. In the 2-month intensive phase, antituberculous therapy includes a combination of four first-line drugs: isoniazid, rifampicin, streptomycin, and pyrazinamide. In the continuation phase, two drugs (isoniazid and rifampicin) are given for 4 months.

As you can see, INH (Isoniazid) is part of both- initial and continuation phases of treatment, and it should be continued for 6 (2+4) months.

The treatment may be altered, if there are side effects due to drugs or if the patient is not responding to treatment.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Sudhir Kumar (6 hours later)

Thank you very much Dr. Sorry but the doctor asked Pyrazinamide and not INH. My bad I wrote it wrong. She should continue with the intitial treating doctor as he asked to stop Pyrazinamide after two months and continue with others????

Follow up: Dr. Sudhir Kumar (7 minutes later)

For the swelling- the doctor has given furosemide 20 mg tablet.

Answered by Dr. Sudhir Kumar (43 hours later)

Brief Answer:
Yes, pyrazinamide should be stopped after two months.

Detailed Answer:
Thank you for getting back.

Yes, pyrazinamide can be stopped after two months, as I mentioned above. Others (Isoniazid and rifampicin) can be continued.

Best wishes,

Dr Sudhir Kumar MD DM

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