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Suggest Alternative Medication For MDR-TB And HIV Infection
Question: hello
i am XXXXXXX i am tb patient (mdr--tb).....presently i am on course from last 2 years using list of medicine as follows 1)pza 1000+750
2)combutol 800+800 mg
3)moximac 400 mg.......
as per the dr. concern ,recently i stopped my medication..... but TB didn't cured for me ....please tell me what i need to do?
can i continue this medicine for few more years or else?
and also one thing i need to say , i am an hiv patient present i using medication "viraday tab" daily once
i am XXXXXXX i am tb patient (mdr--tb).....presently i am on course from last 2 years using list of medicine as follows 1)pza 1000+750
2)combutol 800+800 mg
3)moximac 400 mg.......
as per the dr. concern ,recently i stopped my medication..... but TB didn't cured for me ....please tell me what i need to do?
can i continue this medicine for few more years or else?
and also one thing i need to say , i am an hiv patient present i using medication "viraday tab" daily once
Brief Answer:
MDR-TB and HIV infection
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
Since you have already taken Pyrazinamide(PZA),Ethambuol(combutol) and Moxifloxacin (moximac) for good about 2 years for MDR-TB but no cure and also you stopped medication ,there is no point of continuing the same regime any more.
You need to take anti-tubercular drug to which you have not been exposed,presumably a combination of Eto/Pto( ethionamide or prothionamide),Cs/PAS( cycloserine or para-aminosalicylic acid),later-generation fluoroquinolone, possibly gatifloxacin and or linezolid,as you are likely to be XDR-TB by now.
Since you are also HIV +, avoid Bedaquiline ,a diarylquinoline antibiotic-FDA approved new drug for MDR-TB. Also any injectable anti-tubercular drug is to be avoided for potential risk of HIV transmission.
You need to consult a specialist in Chest and TB for the anti-tubercular regime and duration of treatment and don't discontinue drug without consulting doctor.
Please let me know also ,if you have ever undergone mycobacterial drug susceptibilty testing .
Regards
Dr. T.K. Biswas M.D. XXXXXXX
MDR-TB and HIV infection
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
Since you have already taken Pyrazinamide(PZA),Ethambuol(combutol) and Moxifloxacin (moximac) for good about 2 years for MDR-TB but no cure and also you stopped medication ,there is no point of continuing the same regime any more.
You need to take anti-tubercular drug to which you have not been exposed,presumably a combination of Eto/Pto( ethionamide or prothionamide),Cs/PAS( cycloserine or para-aminosalicylic acid),later-generation fluoroquinolone, possibly gatifloxacin and or linezolid,as you are likely to be XDR-TB by now.
Since you are also HIV +, avoid Bedaquiline ,a diarylquinoline antibiotic-FDA approved new drug for MDR-TB. Also any injectable anti-tubercular drug is to be avoided for potential risk of HIV transmission.
You need to consult a specialist in Chest and TB for the anti-tubercular regime and duration of treatment and don't discontinue drug without consulting doctor.
Please let me know also ,if you have ever undergone mycobacterial drug susceptibilty testing .
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hello,
Dr.T.K.Biswas .
Thanks for answering my question ,till now i didn't gone through the test mycobacterial drug susceptibility testing.
please tell me what is the use for this test.and where can i get this test and how much cost.
and please suggest me xdr-tb medication.
i will clearly mention medications which are used till now for my tb treatment
Rifampin- stopped bcz of body pains
Ethambutol
Streptomycin- used for three months and stopped
cycloserine-replaced after some days instead of pza
pza
levofloxacin-stopped because of joint pains
moxifloxacin
finally i used the combination of
1)pza
2)ethambutol
3)moxifloxacin
4)Streptomycin- used for three months and stopped
5)cycloserine- replaced by pza
so please suggest me the way by seeing my medications
Dr.T.K.Biswas .
Thanks for answering my question ,till now i didn't gone through the test mycobacterial drug susceptibility testing.
please tell me what is the use for this test.and where can i get this test and how much cost.
and please suggest me xdr-tb medication.
i will clearly mention medications which are used till now for my tb treatment
Rifampin- stopped bcz of body pains
Ethambutol
Streptomycin- used for three months and stopped
cycloserine-replaced after some days instead of pza
pza
levofloxacin-stopped because of joint pains
moxifloxacin
finally i used the combination of
1)pza
2)ethambutol
3)moxifloxacin
4)Streptomycin- used for three months and stopped
5)cycloserine- replaced by pza
so please suggest me the way by seeing my medications
Brief Answer:
MDR-TB and susceptibility testing
Detailed Answer:
The best way to treat drug-resistant TB is to know the drugs sensitive to causative Mycobacterial strain .
Isolate of M. tuberculosis is tested for susceptibility to anti-tubercular drugs.
Susceptibility testing may be conducted directly (with the clinical
specimen e.g sputum) or indirectly (with mycobacterial cultures) on solid or liquid medium. Results are obtained rapidly by direct susceptibility testing
on liquid medium, with an average reporting time of 3 weeks.
Since you have failed to respond to initial therapy, expanded susceptibility
testing for second-line anti-TB drugs will be needed.That way it will be possible to know which drugs are effective in your case and remove the drug to which the organism is resistant and continue with the drugs which are sensitive.
Susceptibility testing is done in certain corporate hospital Labs e.g Hinduja hospital in XXXXXXX and also in Govt referral TB hospital e.g Kasturba Hospital again in XXXXXXX
MDR-TB and susceptibility testing
Detailed Answer:
The best way to treat drug-resistant TB is to know the drugs sensitive to causative Mycobacterial strain .
Isolate of M. tuberculosis is tested for susceptibility to anti-tubercular drugs.
Susceptibility testing may be conducted directly (with the clinical
specimen e.g sputum) or indirectly (with mycobacterial cultures) on solid or liquid medium. Results are obtained rapidly by direct susceptibility testing
on liquid medium, with an average reporting time of 3 weeks.
Since you have failed to respond to initial therapy, expanded susceptibility
testing for second-line anti-TB drugs will be needed.That way it will be possible to know which drugs are effective in your case and remove the drug to which the organism is resistant and continue with the drugs which are sensitive.
Susceptibility testing is done in certain corporate hospital Labs e.g Hinduja hospital in XXXXXXX and also in Govt referral TB hospital e.g Kasturba Hospital again in XXXXXXX
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
can you suggest medication for my treatment :
Previously my medication as follows below:
Rifampin- stopped bcz of body pains
Ethambutol
Streptomycin- used for three months and stopped
cycloserine-replaced after some days instead of pza
pza
levofloxacin-stopped because of joint pains
moxifloxacin
finally i used the combination of
1)pza
2)ethambutol
3)moxifloxacin
4)Streptomycin- used for three months and stopped
5)cycloserine- replaced by pza
Previously my medication as follows below:
Rifampin- stopped bcz of body pains
Ethambutol
Streptomycin- used for three months and stopped
cycloserine-replaced after some days instead of pza
pza
levofloxacin-stopped because of joint pains
moxifloxacin
finally i used the combination of
1)pza
2)ethambutol
3)moxifloxacin
4)Streptomycin- used for three months and stopped
5)cycloserine- replaced by pza
Brief Answer:
Suggested treatent for MDR- and XDR-TB
Detailed Answer:
A possible combination of anti-tubercular drugs for MDR-TB would be:
Ethionamide 250 mg CM (morning) and 500 mg HS(bed-time),PAS 4 g orally every 8 h and Linezolid (usually administered at a dose of 600
mg once daily) along with pyridoxine (50–100 mg/d).
Although the optimal duration of treatment is not certain, a course
of at least 20 months is recommended.
Discuss with your doctor.
Suggested treatent for MDR- and XDR-TB
Detailed Answer:
A possible combination of anti-tubercular drugs for MDR-TB would be:
Ethionamide 250 mg CM (morning) and 500 mg HS(bed-time),PAS 4 g orally every 8 h and Linezolid (usually administered at a dose of 600
mg once daily) along with pyridoxine (50–100 mg/d).
Although the optimal duration of treatment is not certain, a course
of at least 20 months is recommended.
Discuss with your doctor.
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Above answer was peer-reviewed by :
Dr. Prasad
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