25m proved case of abdominal tb. Biopsy proved… body wt 53 kg Gene Xpert  m tb complex.. Rifampicin sensitive.. Att started at a reputed mumbai hospital.. Discharge certificate attached I think there a need for discussions.. No.  of drugs Dosage..

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Dear Poddar, Again a wonderful case for discussion. As seen from the discharge summary, it is noticed that they have given the sub optimal doses of AKT. All the low doses of AKT. They have not put him on a quinalone like Moxifloxacin Levofloxacin. RCinex is OK 600/300. Ethambutol should have been 800 mg a day. Pyrazinamide must have been 750 BD. Is there any rationale behind this ??? Abdominal TB Is it separate from Pulmonary Tb ???. Why they have not put on Fluoroquinalone when this is MDR Tb ???. Number of AKT drugs are only four in number. Is this a proper treatment ??? You are my Pulmonology Guru. Please correct me Poddar.

Dear dr mohan it is rifampicin sensitive.. So no mdr
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Thanks everyone We don't expect prescription like this from a tertiary Hospital of a metro city of India. What we know (1) four drugs to start with in a sensitive fresh cases (2) dose of strepomycin if needed should be 0.75 gm (3) pyrazinamide to be given once daily.. Dose 1250-1500 Ethambutol.. Minimum dose 800mg. It is the basic.. To avoid development of new cases of MDR TB..

Thanks a lot dear Poddar, Why they do all sorts of nonsense in big big hospitals???
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underdosing of pza and ethambutol... rcinex is given in correct dose..no need of streptomycin if dis is newly detected case... rifampicin sensitive.. so no need of adding flouroquinolone as asked by Dr Krishna sir...

Thanks everyone for the wonderful discussion and constructive criticism. I think the concerned department should be informed about their mistakes for the shake of the whole humanity in order to prevent emergence of new MDR strains.

Ethambutol 800 to be given pyrazinamide 1250 SM 0.75 all ATT drugs better to be given at Same time approximately, but not to be divided through out the day I think there is no need to put him on quinolone

Drug sensitive abdominal tb. (we must wait for final culture and DST) 1. one must restrcit co prescriptions as much as possible, there is already a pill burden for the pt. 2. yes as told earlier, under dosing ethambutol and pza. 3.streptomycin not required, it is troblesome to take i.m injections, that also when not needed. 4. intensive / continuation phase and follow ups must be planned. 5. such frequent follow up investigations not really required in a young pt with no comorbidities.

not expected from tertiary care hospital . improper dosing one of the major causes of bacterial resistance

All ATT dosages except Rcinex are less accordingly to BW.Inj Strepto 750mg I/M. AST OD, Ethambutol 800 mg OD, PZA 1500 mg OD should be there.

Very fancy and attractive prescription at first look!! But when you start reading it, you find mistakes in it. Etambutol and pyrazinamide are undoerdosed and doses should have been 15-20mg/kg/day and 15-30mg/kg/day respectively. Rest format of prescription is good. Thanks for sharing this one sir.

Ethambutol, pyrazinamide & streptomycin.

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