akt 4 for 2 months and akt3 for 4months given still pt is complaining of cough and blood in sputum for fiften days after ethamsylate blood is under control bt pt is weak again and continous pAin in ribs area sputum and ct scan shows infective tubercluosis wht is to b done next??? should i start akt 4 again or switch to dots or streptomycin inj ??



I request all do not use levofloxacin in patients u are strongly suspecting to be koch s... it's second line treatment for PTB .. if u give it haphazardly for few days in such patient...resistant rates with levofloxacin will increase ...

agree dr.Vora

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send sputum for genexpert test ( rifampicin) / LPA HAIN TEST ( INH/RCIN) ... u will know about rifampicin or rcin and inh resistance... also send sputum for culture and sensitivity to both first line and second line drugs .. if genexpert/lpa showing rifampicin resistance treat as MDR TB

if wt is increasing , appetite is normal and no mdr than i think no rx is required . just give bronchodilator and ethamsilate with tranexamic orally . some times akt will aggravate haemoptysis , give codine syrp . one full course of akt given than healed fibrotic necrotic area blood vesses are occationally bleed.

First to rule out Resistance by sending sputum for GENEXPERT, & rule out bronchiectasis for the reason of hemoptysis.add a quinolones and Inj SM to AKT 3. Further change guided by culture sensitivity report.

c/s of sputum or bronchial lavage, and treat accordingly, i use to send such patients to chest and tb centre Preferly RBT Hospital , Kingsway camp delhi

latest ct scan shows infective tubercluosis codein is given regulrly bt still some cough and pain in ribs akt 3 for 4 month is abt to complete should more akt 3 be given???? gastritis pain in epigastric occssionsly occur loss of apetite

treating tuberculosis thanks to govt of India is a no brainer...but for some reason we still find it confusing. Treating and diagnosing tuberculosis does not cost money. Right from sputum Zn smear till gene xpert and c/s yes...is free of cost. But for that u need to be following Rntcp pathway. ....And Rntcp is changing fast.....

Refer him to pulmonary gist, ,critical care physician

I will like to rule out aspergillosis as cause of haemoptysis

Continue AKT 3 for three months.

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