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Is supervision necessary while on anti-tuberculous treatment?

Q: My 25 years old husband has tuberculosis. He feels drowsy and lethargic after taking the prescribed medicines. He also has a small white patch near his lungs. Will this get cured? He has constant fever and dry cough and his immune system is also weak. How can it be strengthened? He used to be a chain smoker. What is his stage of tuberculosis? Is it early?

A:First of all, I cannot over emphasise the importance of a doctor in supervising the treatment of tuberculosis. I cannot say from the information provided how the diagnosis was made but I assume it was by a clinician using the current diagnostic criteria and techniques.

Your husband needs to have constant supervision when he is under anti-tuberculous treatment for 2 reasons. One is to monitor the disease course itself (regaining the lost weight, regular chest X-rays to see for improvement in TB lesions such as cavitary lesions, infiltrates etc.) and the other is to monitor for known side effects of anti-TB therapy (Liver function tests and , annual eye exams for ethambutol, vitamin B6 supplementation for a known side effect of isoniazid).

All these things are beyond the scope of home treatment without access to a physician/health care practitioner. He needs to have regular scheduled follow up with a physician or health care practitioner well versed in the treatment protocols of tuberculosis.

If the disease is determined not to be responding during the regular follow ups, the doctor may have to test for multi-drug resistant tuberculosis. All these things make follow up with a physician mandatory.

It is hard to tell the "stage" from the supplied information. Coughing up of blood does not denote a known stage of tuberculosis, but tells us that the cavitary lesion in the lung has eroded into a blood vessel.

I recommend that he stay away from smoking forever! It is not only good for his lung health but also his general health as well as. Good diet, healthy dietary practices and exercise are also suggested.

In short, he has to have a doctor supervise his anti-tuberculosis treatment. He has to be away from tobacco forever.

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