Q: Is it alright to take a trial course of ATT when there is a strong clinical suspicion but a definite diagnosis is not forthcoming?

A:A trial course of ATT will have to include all the four drugs viz. rifampicin, isoniazid, ethambutol and pyrazinamide due to the risk of resistance in case the tuberculosis germs are actually present. All these medicines have side effects, some of which are serious like liver damage. Unless the patient is in a remote area where tests cannot be done, one must diagnose before starting a regimen, which may need to be carried on for six months or more. The other problem relates to follow up. Suppose the patient’s condition does not improve, does one stop ATT? May be the patient is not improving because his/her germs are already resistant to two of the four medicines. Suppose it improves, does one continue the medication for six months? It is not at all difficult to make a firm diagnosis of tuberculosis by conducting tests.