A patient in South Africa is started on standard first-line TB treatment (RIPE). Three weeks later, he develops jaundice with AST 450 U/L and ALT 380 ...

Question

A patient in South Africa is started on standard first-line TB treatment (RIPE). Three weeks later, he develops jaundice with AST 450 U/L and ALT 380 U/L (more than 5 times the upper limit of normal). Which drugs should be stopped, and how should treatment proceed?

Accepted Answer

Stop all four drugs; restart ethambutol and streptomycin as a hepato-safe regimen while hepatotoxicity resolves, then sequentially reintroduce hepatotoxic drugs

Answer

Continue all four drugs with close monitoring

Answer

Stop rifampicin only and continue IPE

Answer

Stop isoniazid only and continue RPE

Answer

Stop all drugs permanently and switch to a fluoroquinolone-based regimen

uk-dtmh MCQ (SBA): TB Drug-induced Hepatotoxicity

A patient in South Africa is started on standard first-line TB treatment (RIPE). Three weeks later, he develops jaundice with AST 450 U/L and ALT 380 U/L (more than 5 times the upper limit of normal). Which drugs should be stopped, and how should treatment proceed?