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  • TB 2 Followup

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    John Omandac
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    The patient's antituberculosis treatment should be interrupted due to increased ALT and AST levels. If ALT is more than 3 times the upper normal limit and hepatitis symptoms are present, or if ALT is 5 times the limit even without symptoms, treatment should be stopped. Treatment can only be reintroduced after liver function tests return to normal and symptoms resolve. If signs and symptoms do not improve and liver disease is severe, a non-hepatotoxic regimen of streptomycin, ethambutol and a fluoroquinolone should be used for 18-24 months.

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    TB Pathophysio ClinPhar

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    The patient's antituberculosis treatment should be interrupted due to increased ALT and AST levels. If ALT is more than 3 times the upper normal limit and hepatitis symptoms are present, or if ALT is 5 times the limit even without symptoms, treatment should be stopped. Treatment can only be reintroduced after liver function tests return to normal and symptoms resolve. If signs and symptoms do not improve and liver disease is severe, a non-hepatotoxic regimen of streptomycin, ethambutol and a fluoroquinolone should be used for 18-24 months.

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    6 views1 page

    TB 2 Followup

    Uploaded by

    John Omandac
    The patient's antituberculosis treatment should be interrupted due to increased ALT and AST levels. If ALT is more than 3 times the upper normal limit and hepatitis symptoms are present, or if ALT is 5 times the limit even without symptoms, treatment should be stopped. Treatment can only be reintroduced after liver function tests return to normal and symptoms resolve. If signs and symptoms do not improve and liver disease is severe, a non-hepatotoxic regimen of streptomycin, ethambutol and a fluoroquinolone should be used for 18-24 months.

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    of 1

    2. How should the increase in AST and ALT in this patient be managed?

    What changes
    should be made to the current antituberculosis regimen and/or monitoring plan?
    Treatment should be interrupted and, generally, a modified or alternative regimen used for those
    with ALT elevation more than three times the upper limit of normal (ULN) in the presence of
    hepatitis symptoms and/or jaundice. If ALT is elevated five times the ULN, treatment should
    likewise be interrupted even in the absence of symptoms.
    If TB treatment has been stopped, it is necessary to wait for liver function tests to revert to
    normal and clinical symptoms (nausea, abdominal pain) to resolve before reintroducing the antiTB drugs. If the signs and symptoms do not resolve and the liver disease is severe, the nonhepatotoxic regimen consisting of streptomycin, ethambutol and a fluoroquinolone should
    be started for a total of 1824 months.
    Reference:
    Treatment of tuberculosis: guidelines (4th ed.). (2010). Geneva, Switzerland: World Health
    Organization.

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