TB Cases

Question 1

36yo woman was tested positive for LTBI. She is 10 weeks pregnant. She weighs 75kg. NKDA. Suggest a treatment plan for this patient

Answer 1

• PO Isoniazid 300mg OD (5mg/kg but max is 300mg)
• PO pyridoxine 10mg OD (to minimise neuropathy)

Duration: 9 months

Question 2

45yo man was tested positive for LTBI. He was prescribed Isoniazid, but was unable to tolerate. He weighs 60kg and has no other co-morbidity. NKDA. Suggest a treatment plan for this patient.

Answer 2

PO Rifampicin 600mg OD

Duration: 4 months

Question 3

74 yo man was tested positive for active TB. He weighs 70kg. No renal impairment. NKDA.

Suggest a treatment plan for this patient

Answer 3

2 months of Intensive Phase:

• PO Rifampicin 600mg OD
• PO Isoniazid 300mg OD
• PO Ethambutol 1200mg OD

7 months of continuation phase:

• PO Rifampicin 600mg OD
• PO Isoniazid 300mg OD

OR

• PO Rifampicin 600mg 3x/week
• PO Isoniazid 900mg 3x/week

(Note, patient is elderly, hence using the standard 9 months regimen is more appropriate)

Question 4

36yo man was diagnosed with active TB. He weighs 62kg. No renal impairment, NKDA. He is unable to take ethambutol. He is otherwise healthy

Suggest a treatment plan for this patient

Answer 4

2 months of Intensive Phase:

• PO Rifampicin 600mg OD
• PO Isoniazid 300mg OD
• PO Pyrazinamide 1500mg OD
• IM Streptomycin 1g OD

4 months of continuation phase:

• PO Rifampicin 600mg OD
• PO Isoniazid 300mg OD

OR

• PO Rifampicin 600mg 3x/week
• PO Isoniazid 900mg 3x/week

Question 5

56yo man was diagnosed with active TB. He weighs 67kg. No renal impairment, NKDA. He has HTN and mild dyslipidemia.

Suggest a treatment plan for this patient, and what to look out for when treating the patient’s TB.

Answer 5

2 months of Intensive Phase:

• PO Rifampicin 600mg OD
• PO Isoniazid 300mg OD
• PO Pyrazinamide 1500mg OD
• PO Ethambutol 1200mg OD

4 months of continuation phase:

• PO Rifampicin 600mg OD
• PO Isoniazid 300mg OD

OR

• PO Rifampicin 600mg 3x/week
• PO Isoniazid 900mg 3x/week

When treating, check for DDI with other drugs (especially R and I)

Question 6

35yo man was diagnosed with active TB. He mentions that he does not drink alcohol. He is otherwise a healthy person. He is allergic to penicillin (hives). He does not have renal impairment

Wt.: 48kg

Suggest treatment plan. State whether LFT monitoring is required for this patient, and when should the LFT monitoring be carried out

Answer 6

(note: Always know your tablet size for each drug. Below are just example of doses possible)
2 months intensive phase:
- RIF 500mg PO OD
- INH 300mg PO OD
- PZA 1000mg PO OD
- EMB 1200mg PO OD

4 months continuous phase:

• RIF 500mg PO 3x/week
• INH 900mg PO 3x/week

LFT: Patient has no risk factors for hepatoxicity. Hence, before treatment initiation, baseline LFT checked. During treatment, no need monitoring during treatment

Question 7

26yo F was diagnosed with active TB. She mentions that he does not drink alcohol. She is otherwise a healthy person. She has NKDA and does not have renal impairment

Wt.: 41kg

Suggest treatment plan. State whether LFT monitoring is required for this patient, and when should the LFT monitoring be carried out

Answer 7

2 months intensive phase:

• RIF 400mg PO OD
• INH 300mg PO OD
• PZA 1000mg PO OD
• EMB 800mg PO OD

4 months continuous phase:

• RIF 400mg PO 3x/week
• INH 900mg PO 3x/week

LFT: Patient is female (risk factor). Hence, before treatment initiation, baseline LFT checked. During treatment, check LFT every 2-4 weeks