Is my mother on the right drug regimen?
Q: My mother, 50 years old, has been detected with tuberculosis of the stomach. She was having the problem since approximately 2 months. From a month she has been taking the medicines: Rabifast-20, Razo-20, Xeed-4. Which medicines do you think are appropriate?
A:Your mother is taking 2 drugs (Rabifast and Razo) containing the same compound (rabeprazole - a potent inhibitor of gastric acid output), and Xeed-4 is a combi-kit containing Rifampicin + Isoniazid + Pyrazinamide + Ethambutol (for treatment of TB). Generally, the initial treatment of tuberculosis is with a 4-drug regimen: isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin (as in your mothers case). Once the isolate is known to be fully susceptible, ethambutol (or streptomycin if used as a fourth drug) can be discontinued. After 2 months of therapy (for a fully susceptible isolate), pyrazinamide can be stopped. Isoniazid plus rifampin are continued as daily or intermittent therapy for 4 more months. Therapy must be extended if the patient has cavitary disease or remains culture positive after 2 months of treatment. Directly observed therapy (DOT) is recommended for all patients. Patients on the above regimens as DOT can be switched to 2- to 3-times per week dosing after an initial 2 weeks of daily dosing. Patients on twice-weekly dosing must not miss any doses. Daily therapy is recommended for patients on self-administered medication.