Treatment of patients with impaired liver
Isoniazid, rifampicin and pyrazinamide can cause different liver toxicity Intensity and frequency. The risk of liver side effects increases Through integrated management, abuse of alcohol, and age. In addition, the seized Participants were not included with the established liver disease, though Various observational studies have shown a higher proportion of the liver Toxicity to treat TB in children, women and transporters
Hepatitis B virus (HBV) or hepatitis C virus (HCV)
Reatment for patients with chronic liver disease, especially in advanced clinical stages, patients with acute hepatitis, is complicated It must be done by a specialist. In general, the main recommendations The aim is to avoid using pyrazinamide and use it for longer Treatment regimens involving isoniazid and rifampicin (provided that Are tolerated) in combination with medications with a lower risk of liver Toxicity, such as streptomycin, ethambutol, or fluoroquinolones. this is patients should be monitored closely, clinically and analytically.
Treatment of renal failure patients
Isoniazid and rifampicin are metabolized from the liver. That means that In most patients with renal function change, standard treatment for 6 months The system can be used in regular doses. However, the kidneys do Play a key role in eliminating pyrazinamide and ethambutol (either Their metabolites or unchanged), so dosage should be adjusted with the patient Age and degree of renal failure.
Streptomycin, ethambutol and many other line drugs can cause Renal toxicity. If they should be given because of intolerance or resistance, Dosage should be adjusted according to glomerular filtration rate. In patients undergoing dialysis, drugs must be administered After dialysis, dialysis is also eliminated.
Treatment of pregnant women
Pregnancy and breastfeeding should not affect standard TB Treatment or treatment. There is extensive experience in using standard treatment Systems, currently referred to as pregnant or breastfeeding Women, because of their limited potential to change the development of the human fetus. On doses and throughout standard treatment.
Before starting treatment with other second-line medications, however, the potential benefits and risks must be balanced, as with cycloserine Fluoroquinolones. Streptomycin, kanamycin, protonamide / ethionamide, Amikacin and capreomycin are contraindicated during pregnancy. Various Spanish communities (SEPAR) and international associations