Hyperuricemia on ATT
A 18 year old male patient who has been on treatment for pulmonary tuberculosis for the last 2 months He has been shifted today from Akurit-4 to Akurit-3 as he has completed two months of intensive phase Chief Complaints He had been complaining of pain in ankle joints and heel area too since last 15 days, so I asked him to get uric acid levels done. Investigations His S. Uric Acid is 10.92 as per report he brought today Management My concerns are - 1) The two major drugs causing Hyperuricemia are pyrazinamide and Ethambutol.Out of them pyrazinamide is the major culprit. Pyrazinamide is out of question as he from today he will be on Akurit-3. Does he need any dose reduction in Ethambutol too to prevent further elevation of uric acid? Or we can continue does of Ethambutol? 2) Should a dose of febuxostat 40mg at dinner be added to counter high levels of uric acid, besides dietary modifications?
As now after 2 months- Pyrazinamide is stopped- his s.uric acid will come down . After 2 months of 4 drugs treatment- there is no need to give ethambutal - unless it is a case of Miliary tuberculosis. He can be continued for 4 months on R- Cinex 600 mg only . If need be it can be extended for another 2 months- although this is not the protocol . But - I believe in overtreating tuberculosis than under treating to prevent recurrence.and development of MDR and XDR tuberculosis.. Sometimes in clinical practice- we may have to skip protocols - if it is beneficial to the patient
Anti-tuberculosis drugs such as Pyrazinamide and Ethambutol have been associated with increasing uric acid levels. Although often considered asymptomatic, severe Hyperuricemia can ultimately lead to acute renal failure. Numerous treatment and prevention strategies exist for managing Hyperuricemia. So added you FEBUXOSTAT 40mg at bed time and dietary modifications as per requires.
Add Febuxostate 40 mg.1 tab OD. with present line of treatment. Pl.note that if the pt was not under AKT , 1p.+ Uric acid require Febuxostate 80 mg..x 10 days followed by 40.mg.OD.
NEED'S.. SYMPTOMATIC T/T..
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