A patient with a history of excessive alcohol consumption has been diagnosed with pulmonary tuberculosis due to cough, fever, expectoration, and sputum culture isolation of Mycobacterium tuberculosis. The patient started treatment with isoniazid, rifampicin, ethambutol and pyrazinamide, with adequate tolerance. Twenty days after starting treatment, a report of rifampicin resistance of M. tuberculosis isolated in sputum is received. Which regimen would you select based on this report?
Another question that may generate discussion. When a diagnosis of active tuberculosis infection is made, treatment is initiated with isoniazid, rifampicin and pyrazinamide together with ethambutol in case of suspicion of strains resistant to any of the drugs. Once the existence of resistance has been ruled out, ethambutol can be dispensed with. In case of resistance to rifampicin, rifampicin is withdrawn and treatment is completed with the 3 remaining drugs for 12 months. The option of adding a quinolone during the first two months of treatment (moxifloxacin or levofloxacin) is considered in cases of extensive pulmonary involvement. In this case, they do not tell us anything about extensive pulmonary involvement but they give us a data "excessive alcohol consumption". You know that in the MIR no data is free, and if the person who posted this question wanted to reflect it, probably his intention was that we reflect on it. Alcohol exerts a direct immunosuppressive effect, moreover, alcoholism is related to the affectation of immunity in the respiratory tract. The social context that usually accompanies the alcoholic patient does not help either. All the factors mentioned above make us lean more towards answer number 3, although it is undeniable that number 1 could also be correct.
Isoniazid, ethambutol, pyrazinamide for 12 months.
Isoniazid, ethambutol, pyrazinamide for 12 months and streptomycin for two months.
Isoniazid, ethambutol, pyrazinamide for 12 months and a quinolone for two months.
Isoniazid, ethambutol, pyrazinamide and a quinolone for 18 months.
Isoniazid, ethambutol, pyrazinamide for 18 months and streptomycin and a quinolone for 2 months.
Alcohol exerts a direct immunosuppressive effect, moreover, alcoholism is related to the affectation of immunity in the respiratory tract.