Is stopping intestinal TB drugs after 5 months safe?

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

You have been on anti-tuberculosis medicines for about five months for intestinal tuberculosis, and now your ultrasonography shows the lymph node has become necrotic and has not reduced in size, plus your doctor stopped a few drugs recently. That can be confusing, I understand.

It looks like the doctor might have stopped those three medicines, P-Zid (Pyrazinamide), Combutol (Ethambutol), and Fbx (Febuxostat), because of some liver or blood changes on your latest reports, which can happen after several months on tuberculosis treatment. Ethambutol and Pyrazinamide can especially stress the liver.

I suggest you undergo these investigations:

1. I would want to see your latest liver function test and complete blood count values, and also if any symptoms like yellow eyes, nausea, itching, or loss of appetite are present.

2. If possible, repeat a liver function test after 10 to 15 days.

3. Sometimes, a follow-up abdominal ultrasound or computed tomography after two months helps to check the response.

Differential diagnosis is as follows:

1. Drug-induced hepatitis.

2. Slow-responding or resistant tuberculosis.

3. Post-inflammatory necrotic lymph node.

Probable diagnosis is intestinal tuberculosis with treatment-related hepatotoxicity.

I suggest you follow the instructions mentioned below:

1. Do not restart the stopped medicines on your own. Continue only what your treating doctor has allowed, that is Rablet-D (Rabeprazole with Domperidone), Rcenix (Rifampicin), Benadon (Pyridoxine), and Eduhep. These protect your liver and stomach.

2. The tuberculosis team usually reintroduces the other drugs slowly once your liver enzymes normalize. Five months is not too short; tuberculosis regimens are sometimes adjusted midway due to side effects. Stick to your doctor’s advice and get the next review soon.

3. Upload or share your latest liver function test report here.

4. Also mention if you have yellowing of the eyes, fatigue, or appetite loss.

5. Follow up with your treating gastroenterologist or the directly observed treatment, short-course (DOTS) center doctor soon; they will guide if modified therapy is needed. Do not change anything without their input.

6. Eat light, liver-friendly food (avoid oily and spicy items), stay hydrated, and avoid alcohol or painkillers unless prescribed.

7. Maintain proper nutrition, add boiled eggs, lentils, curd, and fruits if your stomach allows.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern.

You are five months into anti-tuberculosis therapy for intestinal tuberculosis, and your doctor has stopped Pyrazinamide (P-Zid), Ethambutol (Combutol), and Febuxostat (FBX). That is actually not unusual after this point.

The standard course has an intensive phase (first two months) and a continuation phase (next four to seven months). By the fifth month, many doctors stop those first-line drugs that can stress the liver or kidneys if your liver function test is showing strain.

So if your treating doctor checked your liver function test and stopped those based on it, it is safe. Do not restart on your own; that can be dangerous.

The probable cause is mild drug-induced liver stress or toxicity, which was seen on the liver function test, so the doctor reduced the load by stopping P-Zid (Pyrazinamide) and Combutol (Ethambutol). FBX (Febuxostat) for uric acid becomes unnecessary once P-Zid (Pyrazinamide) is stopped.

I suggest you follow these investigations:

1. Repeat liver function test after 10 to 14 days.

2. Complete blood count for trend.

3. Ultrasonography abdomen after one to two months to check node size.

4. If a persistent necrotic node, consider computed tomography abdomen after completing therapy.

Differential diagnoses are as follows:

1. Residual lymphadenitis after healed tuberculosis.

2. Drug-induced hepatitis.

3. Resistant tuberculosis (less likely if symptoms are improving).

Probable diagnosis is intestinal tuberculosis (on continuation phase).

I suggest you follow the instructions mentioned below:

1. Continue the rest of the medicines, R-cinex (Rifampicin + Isoniazid), Benadon (Pyridoxine), Rablet-D (Rabeprazole with Domperidone), and Eduhep, exactly as advised.

2. Do not restart the stopped ones unless your treating doctor restarts them after reviewing your next test.

3. Eat small, soft, high-protein meals to maintain nutrition.

4. Drink plenty of water.

5. Fear of obstruction is common, but since ultrasonography shows no ascites or obstruction now, you can gradually increase food quantity under supervision.

6. Share your next liver function test and complete blood count results once done. Also mention if you develop yellow eyes, nausea, or pain in the right upper abdomen.

If the necrotic node does not shrink after completion, your doctor may repeat imaging or consider a biopsy to rule out resistant tuberculosis. Follow up with your gastroenterologist, too.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.