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Why Is Moxifloxacin Prescribed For A Patient With Elevated ALT Levels?
Question: Dear Doctro Bhavsar, I hope you remember me. This is XXXX XXXXXXX TB patient from UK who had contacted you regarding treatment process here. I dont know but previous questions page has been closed so I have started again. I hope this is fine. My ALT readings came down to 198 last week and Dr here restarted Ethambutol 1300mg and Moxifloxacin 400mg. After two day they did ALT. came to 130. so added Isoniazid first day 75mg, second day 150mg, third day 300mg. they did ALT again and came to 90. So from today they have added Rifampicin 150mg and tomorrow I will take Rifampicin 300mg and they will do ALT again. Basically they are checking which drug is causing ALT elevation. And lastly they may introduce Pyrazinamide. I hope they are going in right way. Please comment. Why they have started with Moxifloxacin?
Brief Answer:
Ideally levofloxacin should be started.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
Yes, I remember you.
Yes, the doctors in UK are doing correct thing.
Continue their regimen.
Honestly speaking even I am surprised by seeing moxifloxacin in the prescription.
Actually it is reserved drug for XDR (extreme drug resistance) tuberculosis.
Instead of moxifloxacin, you should have given levofloxacin.
Did you ask your doctor why she started moxifloxacin?
Please reply me answer of above asked question, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.
Ideally levofloxacin should be started.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
Yes, I remember you.
Yes, the doctors in UK are doing correct thing.
Continue their regimen.
Honestly speaking even I am surprised by seeing moxifloxacin in the prescription.
Actually it is reserved drug for XDR (extreme drug resistance) tuberculosis.
Instead of moxifloxacin, you should have given levofloxacin.
Did you ask your doctor why she started moxifloxacin?
Please reply me answer of above asked question, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr Bhavsar, Thanks for your reply. Today at blood test time I asked the nurse about Moxifloxacin. The Dr was not available. Nurse said because they have removed Pyrazinamide they have to replace it with some better second line drug. I am not sure about this but this is what they do to other patients as well. So far there is no indication of ALT elevation. Today I took full strength dose of INH, Rifampicin, Ethambutol and Moxifloxacin. After that they took my blood and awaiting for ALT. They said if nothing to worry then they will not call me. I should continue taking full dose until next Wednesday and they will do test again.
1> Does this mean they will continue same medicines for full treatment if ALT remains acceptable?
2> Should they introduce Pyrazinamide later?
3> I am getting bit more cough since yesterday. Is it because my TB is getting worse or this is temporary? I am not feeling sick other than more cough than last week.
Awaiting your reply. Thanks.
1> Does this mean they will continue same medicines for full treatment if ALT remains acceptable?
2> Should they introduce Pyrazinamide later?
3> I am getting bit more cough since yesterday. Is it because my TB is getting worse or this is temporary? I am not feeling sick other than more cough than last week.
Awaiting your reply. Thanks.
Brief Answer:
This cough is temporary.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Well in such case, they should have started levofloxacin, not moxifloxacin.
But as you are taking treatment in UK, you have to follow what they are doing.
Answer to your 1st question.
No, I don't think they will continue with moxifloxacin. They will start pyrazinamide in the next week if your ALT remains normal.
Answer to your 2nd question.
Yes, they will mostly reintroduce pyrazinamide in the next week if your ALT remains normal.
Answer to your 3rd question.
This cough is temporary. I don't think it is due to worsening of underlying tuberculosis.
Hope I have solved your query. If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar. Wish you good health. Thanks.
This cough is temporary.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Well in such case, they should have started levofloxacin, not moxifloxacin.
But as you are taking treatment in UK, you have to follow what they are doing.
Answer to your 1st question.
No, I don't think they will continue with moxifloxacin. They will start pyrazinamide in the next week if your ALT remains normal.
Answer to your 2nd question.
Yes, they will mostly reintroduce pyrazinamide in the next week if your ALT remains normal.
Answer to your 3rd question.
This cough is temporary. I don't think it is due to worsening of underlying tuberculosis.
Hope I have solved your query. If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar. Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks doctor.
Well they have called me next week Wednesday for ALT test again and I will see Dr on that day. Let us see what he says about Moxifloxacin and start of pyrazinamide. I will update you next week.
By the way what kind of food I should take or avoid during this TB treatment considering liver as well?? I have not eaten spicy or oily food since one month but craving for that :). Please advice.
Thanks.
Well they have called me next week Wednesday for ALT test again and I will see Dr on that day. Let us see what he says about Moxifloxacin and start of pyrazinamide. I will update you next week.
By the way what kind of food I should take or avoid during this TB treatment considering liver as well?? I have not eaten spicy or oily food since one month but craving for that :). Please advice.
Thanks.
Brief Answer:
You can eat routine spicy and oily food.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
You should not take excess of oil and spices in food.
But routine oily and spicy food is allowed.
Avoid cheese and paneer.
Drink plenty of fluids orally and keep your self hydrated. Take high fiber diet.
Avoid alcoholic drinks.
And yes, I will be happy to receive your question on next Wednesday.
I forgot to ask about your wife.
How's she?
You can eat routine spicy and oily food.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
You should not take excess of oil and spices in food.
But routine oily and spicy food is allowed.
Avoid cheese and paneer.
Drink plenty of fluids orally and keep your self hydrated. Take high fiber diet.
Avoid alcoholic drinks.
And yes, I will be happy to receive your question on next Wednesday.
I forgot to ask about your wife.
How's she?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for your reply.
Dr will see my wife on next Wednesday as well to discuss CT scan report. Nurse told me that she does not know about CT result but has to be normal because Dr has not asked her to contact my wife urgently and given standard appointment to see her after two weeks.
My wife's cough has subsided a lot and she is feeling better than last week. So probably it wasn't active TB but we will know for sure on next Wednesday. Dr probably will discuss about Latent TB treatment.
Regards.
Dr will see my wife on next Wednesday as well to discuss CT scan report. Nurse told me that she does not know about CT result but has to be normal because Dr has not asked her to contact my wife urgently and given standard appointment to see her after two weeks.
My wife's cough has subsided a lot and she is feeling better than last week. So probably it wasn't active TB but we will know for sure on next Wednesday. Dr probably will discuss about Latent TB treatment.
Regards.
Brief Answer:
What about her infertility issue?
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
This is good news that her CT scan is mostly normal.
I was asking about her infertility issue.
Have you discussed genital tuberculosis with her gynecologist?
When will you see gynecologist for her?
What about her infertility issue?
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
This is good news that her CT scan is mostly normal.
I was asking about her infertility issue.
Have you discussed genital tuberculosis with her gynecologist?
When will you see gynecologist for her?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
No we have not seen gynecologist recently. The system here works in such a way that to get appointment with gynecologist on non urgent cases will take 2-3 months. We can ask her GP, a General Practitioner - first contact Dr for all problems and then he/she decides if consultant appointment is needed. OR we can consult some private gynecologist.
We have done all other tests needed including Thrombopholia, immunity, NK cell assay, Ultrasounds, AMH, FSH, thyroid etc.. Nothing adverse was found. Even her remaining fallopian tube was tested and it was open and fine. So far no indication of anything particularly wrong.
How common is this genital TB? If she had genital TB, how do we test it? What are the symptoms?
Regards.
No we have not seen gynecologist recently. The system here works in such a way that to get appointment with gynecologist on non urgent cases will take 2-3 months. We can ask her GP, a General Practitioner - first contact Dr for all problems and then he/she decides if consultant appointment is needed. OR we can consult some private gynecologist.
We have done all other tests needed including Thrombopholia, immunity, NK cell assay, Ultrasounds, AMH, FSH, thyroid etc.. Nothing adverse was found. Even her remaining fallopian tube was tested and it was open and fine. So far no indication of anything particularly wrong.
How common is this genital TB? If she had genital TB, how do we test it? What are the symptoms?
Regards.
Brief Answer:
Incidence varies according to type of infertility.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
This system is not good. If your GP is not good then he may miss something and delay the diagnosis.
Well incidence of genital tuberculosis varies with type of infertility.
There are two types of infertility.
1. Primary
2. Secondary.
Primary means female is not able to concive any baby.
Secondary means female had delivered healthy baby in the past and now she is not able to concive.
So which infertility is there in your wife?
Do you have any child?
Incidence varies according to type of infertility.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
This system is not good. If your GP is not good then he may miss something and delay the diagnosis.
Well incidence of genital tuberculosis varies with type of infertility.
There are two types of infertility.
1. Primary
2. Secondary.
Primary means female is not able to concive any baby.
Secondary means female had delivered healthy baby in the past and now she is not able to concive.
So which infertility is there in your wife?
Do you have any child?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
We are trying for our first baby.
We started trying in early 2014. She got pregnant but at 8 weeks she had miscarriage. so she had D&C. She got pregnant again end of 2014 but it was tubal ectopic. So her right tube was removed. in late 2015 she got pregnant but was early miscarriage at 5 weeks.
We are seeing private gynecologist for IVF treatment and done all the tests needed. All are fine except her low AMH which indicates she has low eggs reserve. Other things are ok.
She had conceived but could not progress beyond 8 weeks. So gynecologist says because reports are normal except AMH, its just bad luck.
We are planning to start IVF medicines after seeing TB Dr.
Do you think Latent TB treatment will interfere with IVF process? Or can we start Latent TB treatment few months after doing IVF? How likely and how soon this latent TB is to become active if my wife is healthy otherwise?
Thanks.
We are trying for our first baby.
We started trying in early 2014. She got pregnant but at 8 weeks she had miscarriage. so she had D&C. She got pregnant again end of 2014 but it was tubal ectopic. So her right tube was removed. in late 2015 she got pregnant but was early miscarriage at 5 weeks.
We are seeing private gynecologist for IVF treatment and done all the tests needed. All are fine except her low AMH which indicates she has low eggs reserve. Other things are ok.
She had conceived but could not progress beyond 8 weeks. So gynecologist says because reports are normal except AMH, its just bad luck.
We are planning to start IVF medicines after seeing TB Dr.
Do you think Latent TB treatment will interfere with IVF process? Or can we start Latent TB treatment few months after doing IVF? How likely and how soon this latent TB is to become active if my wife is healthy otherwise?
Thanks.
Brief Answer:
If she is having latent TB then you should first treat it before IVF treatm
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
I am sorry after hearing all these.
Well I also think that it is only bad luck.
I don't think she is having genital tuberculosis.
Because genital tb patients can not concive at all.
Your wife is able to concive. Si possibility of genital tb is less likely in her case.
Even if she is having latent TB, then treatment for TB should be started first before IVF treatment.
TB treatment does not interact with IVF treatment. But better to treat tb first if she is found to have tb.
If she is cleared of tb then no need to think about tuberculosis.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wish you and your wife good health. Thanks.
If she is having latent TB then you should first treat it before IVF treatm
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
I am sorry after hearing all these.
Well I also think that it is only bad luck.
I don't think she is having genital tuberculosis.
Because genital tb patients can not concive at all.
Your wife is able to concive. Si possibility of genital tb is less likely in her case.
Even if she is having latent TB, then treatment for TB should be started first before IVF treatment.
TB treatment does not interact with IVF treatment. But better to treat tb first if she is found to have tb.
If she is cleared of tb then no need to think about tuberculosis.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wish you and your wife good health. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
She has so far only TB skin test positive. All other things look normal.
Does this mean she has Latent TB?
Regards.
She has so far only TB skin test positive. All other things look normal.
Does this mean she has Latent TB?
Regards.
Brief Answer:
Skin TB test is not reliable.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Now a days, skin TB test is not reliable for the diagnosis of latent TB infection.
Recent studies from WHO said so.
Almost all Indians will come skin TB test positive.
Wait let me clear one thing first.
Is your wife XXXXXXX or non indian?
Because a lot depend on the above fact.
Please reply me answer of above asked question, so that I can guide you better. I will be happy to help you further. Wishing both of you good health. Thanks.
Skin TB test is not reliable.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Now a days, skin TB test is not reliable for the diagnosis of latent TB infection.
Recent studies from WHO said so.
Almost all Indians will come skin TB test positive.
Wait let me clear one thing first.
Is your wife XXXXXXX or non indian?
Because a lot depend on the above fact.
Please reply me answer of above asked question, so that I can guide you better. I will be happy to help you further. Wishing both of you good health. Thanks.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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