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Suggest Treatment For Pleural Effusion
Question: My father (67 yrs old) was administered Forecox tablets after he was diagnosed with pleural effusion. The water that was extracted was straw colored. There was no evidence of cardiac problems, or malignancy as such. The reports "suggested" tubular infection, though it did not pin point tuberculosis as the cause. His liver state is healthy, and so is the CBC figures.
As he is taking the TB medicine, there is no increase in pleural fluid accumulation in the lungs, and it is decreasing slowly.
My question is, in the absence of a "pin pointed" infection/cause, what else should we be looking into in rder to make sure that the treatment goes as per the medical books?
As he is taking the TB medicine, there is no increase in pleural fluid accumulation in the lungs, and it is decreasing slowly.
My question is, in the absence of a "pin pointed" infection/cause, what else should we be looking into in rder to make sure that the treatment goes as per the medical books?
Brief Answer:
ATT should be given according to weight.
Detailed Answer:
Hello dear, thanks for your question on HCM.
I can understand your situation and problem.
Since your father is improving with treatment (forecox), I think it is tubercular pleural effusion only.
Following are the things you should see in a patient taking anti tuberculosis drugs (forecox) to improve outcome and prevention of drug resistance.
1. Anti TB Treatment (ATT) should be given according to the weight.
2. ATT should be given simultaneously, at a time. Not in split way like 1 tablet in morning and other in afternoon or night.
3. Best way to take ATT is , in the morning on empty stomach. But if gastritis is an issue than patient can take after light breakfast.
4. Absence of fever is the earliest marker of improvement.
5. With this ,improvement in appetite,weight gain ,subjective well being etc are other supportive evidence of correct treatment.
6. X ray Improvement will take time. So if he is symptomatically improving then no need to worry much.
7. Just make sure that treatment should be continued for at least 6 months. 2 months of intensive phase (4 drugs) and 4 months of continuation phase (4 months).
So above are the things you should look precisely in patient who is on empirical (absence of strong evidence) ATT.
Reply me his weight, number of forecox tablets he is taking and symptomatic improvement is there or not. So that I can guide you better.
I will be happy to help you further.
Wishing good health to your father.
Thanks.
ATT should be given according to weight.
Detailed Answer:
Hello dear, thanks for your question on HCM.
I can understand your situation and problem.
Since your father is improving with treatment (forecox), I think it is tubercular pleural effusion only.
Following are the things you should see in a patient taking anti tuberculosis drugs (forecox) to improve outcome and prevention of drug resistance.
1. Anti TB Treatment (ATT) should be given according to the weight.
2. ATT should be given simultaneously, at a time. Not in split way like 1 tablet in morning and other in afternoon or night.
3. Best way to take ATT is , in the morning on empty stomach. But if gastritis is an issue than patient can take after light breakfast.
4. Absence of fever is the earliest marker of improvement.
5. With this ,improvement in appetite,weight gain ,subjective well being etc are other supportive evidence of correct treatment.
6. X ray Improvement will take time. So if he is symptomatically improving then no need to worry much.
7. Just make sure that treatment should be continued for at least 6 months. 2 months of intensive phase (4 drugs) and 4 months of continuation phase (4 months).
So above are the things you should look precisely in patient who is on empirical (absence of strong evidence) ATT.
Reply me his weight, number of forecox tablets he is taking and symptomatic improvement is there or not. So that I can guide you better.
I will be happy to help you further.
Wishing good health to your father.
Thanks.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Thank you Doctor.
Here are the details.
1) His weight is 60 KGs.
2) He is taking two Forecox tablets together in the morning after having a light breakfast. The Forecox tablets do not mention any figures w r.t. the strength (I guess it is not supposed to have?).
3) He does have an appetite
4) He has no fever.
One question, he feels weak once he takes the Forecox tablets. Is this normal? Also it is advised to east as much protein and vitamin rich food during this phase of 6 months of treatment. Do you know of any restrictions w.r.t. food?
For point #7, you had mentioned two phases of the treatment. The first two months intensive- meaning two tabs per day, while the rest 4 months continuation (one tab per day?). Am I right in this understanding?
Here are the details.
1) His weight is 60 KGs.
2) He is taking two Forecox tablets together in the morning after having a light breakfast. The Forecox tablets do not mention any figures w r.t. the strength (I guess it is not supposed to have?).
3) He does have an appetite
4) He has no fever.
One question, he feels weak once he takes the Forecox tablets. Is this normal? Also it is advised to east as much protein and vitamin rich food during this phase of 6 months of treatment. Do you know of any restrictions w.r.t. food?
For point #7, you had mentioned two phases of the treatment. The first two months intensive- meaning two tabs per day, while the rest 4 months continuation (one tab per day?). Am I right in this understanding?
Brief Answer:
It is normal to have some weakness.
Detailed Answer:
Hello dear,
Thanks for your follow up question.
Yes, it is normal to have some weakness after forecox tablets. You can give antacids to prevent it. And no need to worry for dose. As 2 tablets of forecox is appropriate for 60 kg individual.
And he can take after light breakfast. No harm in it.
Regarding food, I advice not to take too much oily and spicy food. This is to prevent hyperacidity and gastritis. Otherwise no food restriction for him.
And yes, protein and vitamin rich diet is advised in TB patients to build immunity and fasten the recovery.
Forecox is having 4 drugs.
1. Rifampicin
2. Isoniazide
3. Pyrazinamide
4. Ethambutol.
These drugs should be given for 2 months only as intensive phase.
For the remaining 4 months of continuation phase only 2 drugs (rifampicin and isoniazide) are given. So Forecox will be replaced in last 4 months. For this regular follow up with your treating doctor is needed.
Hope I have solved your queries.
If you are not having further queries, then please close the conversation and rate the answer.
Wishing good health to your father.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Thanks.
It is normal to have some weakness.
Detailed Answer:
Hello dear,
Thanks for your follow up question.
Yes, it is normal to have some weakness after forecox tablets. You can give antacids to prevent it. And no need to worry for dose. As 2 tablets of forecox is appropriate for 60 kg individual.
And he can take after light breakfast. No harm in it.
Regarding food, I advice not to take too much oily and spicy food. This is to prevent hyperacidity and gastritis. Otherwise no food restriction for him.
And yes, protein and vitamin rich diet is advised in TB patients to build immunity and fasten the recovery.
Forecox is having 4 drugs.
1. Rifampicin
2. Isoniazide
3. Pyrazinamide
4. Ethambutol.
These drugs should be given for 2 months only as intensive phase.
For the remaining 4 months of continuation phase only 2 drugs (rifampicin and isoniazide) are given. So Forecox will be replaced in last 4 months. For this regular follow up with your treating doctor is needed.
Hope I have solved your queries.
If you are not having further queries, then please close the conversation and rate the answer.
Wishing good health to your father.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Thanks.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Answered by
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