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Welcome To 'Ask A Doctor'. Please Type Your Question Here...mother

Posted on Sat, 20 Apr 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. Monish De (2 hours later)

Brief Answer:
Continue inh

Detailed Answer:
Hi

As your mother was diagnosed with spinal tb and was under treatment and isoniazid or inh stopped due to swelling i do not think it was right

Inh has no relation with swelling.

Would advise your mother to do kidney functiin tests, urine test and 2 D Echocardiography to find the cause of swelling and continue inh with other anti tubercular medicines

Regards

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Monish De (5 hours later)

Sir, all these tests were done except for echo. All the results were negative.

Follow up: Dr. Monish De (0 minute later)

Also, my bad I wrote the wrong medicine- it was Pyrazinamide which was stopped and not INH.

Follow up: Dr. Monish De (5 minutes later)

For the swelling- the doctor has given Furosemide 40 mg tablet.

Answered by Dr. Monish De (13 minutes later)

Brief Answer:

Furosemide is a diuretic and it will work for swelling in your case

Detailed Answer:

Hi

I have gone through your reports

Pyrazinamide causes side effects such as pain in large and small joints and pain and swelling of joints, especially big toe, ankle, and knee

Furosemide is a diuretic and it will work for swelling in your case

Get an 2 D echocardiography test and kidney function test done

Regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Monish De (1 hour later)

KFT was negative. No abnormal results. Will ask her to go for an ECHO.

So she is fine with Pyrazinamide being stopped?

Thank you very much for your reply!

Answered by Dr. Monish De (12 minutes later)

Brief Answer:

Pyrazinamide can be restarted

Detailed Answer:

Hi

If echocardiography is normal then pyrazinamide can be restarted

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Monish De (59 minutes later)

Pyrazinamide was stopped 3 days before swelling developed. Pyrazinamide was stopped after two months of ATT as my mother had shown great improvement. Please advise. Thank You!

Follow up: Dr. Monish De (4 minutes later)

Pyrazinamide was NOT STOPPED due to swelling. It was stopped after two months of ATT as my mother had shown great improvement after two months. Also, I guess the intensive phase of TB management is 2 months only. Swelling developed 2 days after it was stopped. We went to another doctor for a second opinion, he said that pyrazinamide should not have been stopped- which is why this is my concern. who to listen?

Answered by Dr. Monish De (50 minutes later)

Brief Answer:
Stopping pyrazinamide after 2 months was right

Detailed Answer:
Hi

Pyrazinamide is only used for 2 months in tuberculosis in intensive phase

So stopping of drug after 2 months was right.

Swelling has no relation to pyrazinamide and other causes need to be be found out

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Monish De (1 hour later)

Thank you very much Dr. Monish De for taking the time to answer my questions. Your help is very much appreciated.

Answered by Dr. Monish De (11 hours later)

Brief Answer:
Thanks for consulting me online

Detailed Answer:
Hi

If you have no more queries please close the thread and rate the answers.

Regards

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj