Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Pulmonary TB And Liver Cirrhosis
Question: Sir,i am lever cirrohsis patient,recetly i diagnosed with pulmonary tb.i having pleural effusion in right lung,fluid is removed by doctor. I am on treatment of ethambutol 1200mg,streptomycin 1gm injection alternate day,and levofloxcin 750mg daily.cough subsides on removing fluid but ocassionaly i have.i have evening rise of temprature but never goes abovr 98.6f.no weight loss.now my problem is that i always feel cold in day my palms and feet sweats and i feel much cold.and in night sweats also occurs.five weeks are gone on taking treatment.is i am on right track of treatment
Brief Answer:
Ethambutol, quinolones, aminoglycosides are safe in cirrhosis.
Detailed Answer:
Hi,
Welcome to health care magic,
In liver cirrhotics patients, 3 of the 5 first line anti-tubercular drugs are potentially hepatotoxic in which pyrazinamide has the highest hepatoxicity followed by rifampin and isoniazid.
The safe anti tubercular drugs are Ethambutol, quinolones, aminoglycosides and cycloserine.
The administration of these drugs (pyrazinamide, rifampin and isoniazid) can lead to further worsening LFT with de-compensation of stable cirrhotics and sometimes cause fulminant hepatic failure.
Your pleural effusion could be due to pulmonary tuberculosis and when the fluid is drained you might have been relieved from the symptoms of breathlessness and cough.
Your mild fever,cold or night sweat could be because of mycobacteria present in the lungs or might be the effect of this anti-tb medications.Night sweats are usually not a cause for concern but you can ask for symptomatic treatment like antihistamines to your chest physician.
Your case is 'no hepatotoxic drugs AKT' (Category B & C AKT in liver disease) which will require 18–24 months of Streptomycin, ethambutol and quinolones for complete course in cirrhosis (liver disease) which should be monitored by liver function tests regularly throughout TB treatment.
You can go for sputum culture for AFB after 2 months of completing treatment.
Thanks and Regards,
Dr.SandipKabra.
Ethambutol, quinolones, aminoglycosides are safe in cirrhosis.
Detailed Answer:
Hi,
Welcome to health care magic,
In liver cirrhotics patients, 3 of the 5 first line anti-tubercular drugs are potentially hepatotoxic in which pyrazinamide has the highest hepatoxicity followed by rifampin and isoniazid.
The safe anti tubercular drugs are Ethambutol, quinolones, aminoglycosides and cycloserine.
The administration of these drugs (pyrazinamide, rifampin and isoniazid) can lead to further worsening LFT with de-compensation of stable cirrhotics and sometimes cause fulminant hepatic failure.
Your pleural effusion could be due to pulmonary tuberculosis and when the fluid is drained you might have been relieved from the symptoms of breathlessness and cough.
Your mild fever,cold or night sweat could be because of mycobacteria present in the lungs or might be the effect of this anti-tb medications.Night sweats are usually not a cause for concern but you can ask for symptomatic treatment like antihistamines to your chest physician.
Your case is 'no hepatotoxic drugs AKT' (Category B & C AKT in liver disease) which will require 18–24 months of Streptomycin, ethambutol and quinolones for complete course in cirrhosis (liver disease) which should be monitored by liver function tests regularly throughout TB treatment.
You can go for sputum culture for AFB after 2 months of completing treatment.
Thanks and Regards,
Dr.SandipKabra.
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
