How to manage drug resistant tuberculosis?
Q: My wife was diagnosed to be suffering from pulmonary TB in 2001. She received full ATT for 9 months, INH, Rcin, PZA, Ethambutol x 3 months and INH + RCIN + Ethambutol for 6 months. The lesions never resolved, remained confined and did not grow. BIOPSY was +ve for AFB. On C/S AFB was found resistant to Rcin, Strepto and INH. So she was started on Kanamycin, Ethambutol + PZA + Oflx + Cycloserine + Ethionamide. After 2&1/2 months of treatment LFT went up, so Ethionamide and Cycloserine and PZA were stopped. As the LFT returned (in 2 weeeks) to Normal, Cycloserine was reintroduced, and 10 days later after checking LFT, Ethionamide was added. After introduction of Ethionamide, LFT went up again. What are the options available for treatment now, seems like we have exhausted all the available drugs. What should be the continuation phase treatment?
A:I need to know where the disease is whether in the lungs or lymph nodes? Your wife should continue on the following drugs in proper doses. Rifampicin, Isoniazid, Ethambutol, Cycloserine, Levofloxacin and Streptomycin or Kanamycin till at least six months after the disease has been cured. There is still a chance of a cure if the treatment is continued in the proper manner.