Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.

1. Dr. Sachin Verma MD, FICM, FCCS, ICFC
Fellowship in Intensive Care Medicine
Infection Control Fellows Course
Consultant Internal Medicine and Critical Care
Web:- http://www.medicinedoctorinchandigarh.com
Mob:- +91-7508677495

2. Anti tuberculosis
treatment in special
clinical situations

3. Pregnancy
 WHO - 2HRZE+ 4HR
 AMERICAN THORACIC SOCIETY
- 2HRE +7HR
(Z is not recommended in USA due to
lack of its teratogenicity data)
 Streptomycin is contraindicated as it causes
8th CN damage in fetus

4. Breast feeding
 No contraindication for ATT.
 Most of the drugs administered will be present
in small quantities in breast milk, but at a
concentration far to low to provide any
therapeutic or prophylactic benefit to child.
 Prophylactic Isoniazid is given for at least 3
months beyond the time mother is
noninfectious.
 BCG vaccination should be postponed until end
of Isoniazide prophylaxis.

5. Oral contraception
 Rifampicin interacts with oral contraceptives
with a risk of decreased protective efficacy
against pregnancy.
 2 options are there
a. Use OCP containing a higher dose
estrogen.
b. Use another form of contraception

6. ATT induced hepatitis
 Rule out other causes of hepatitis.
 In drug induced hepatitis ATT should be stopped.
 Wait for an extra 2 week before recommencing TB
treatment after jaundice has disappeared.
 Once drug induced hepatitis has resolved, same drugs
are reintroduced one at a time.

7.  Avoid Pyrazinamide.
 Preferred regimen 2SHE+10HE.
 In severely ill TB patient with hepatitis in
whom withdrawing ATT will lead to fatal
complications, patient should be treated with
Streptomycin and Ethambutol. After hepatitis
has resolved, usual TB treatment should be
restarted.

8. Renal failure
 Aminoglycosides are contraindicated.
 In mild to moderate renal failure HRZ should
be used,
 In severe renal failure, reduce the dose of
Isoniazide and Pyrazinamide, except in
patients with hemodialysis.
 Ethambutol should only be used when
plasma levels can be monitored.

9. HIV and ATT
 The standard treatment is equally efficacious
in HIV +ve and HIV –ve patients.
 3 important considerations in patients of HIV
are
a. An increased frequency of paradoxical
reactions
b. Drug interaction between HAART and
Rifampicin
c. NRTIS and Isoniazid

10.  Possible options for antiretroviral therapy in
TB patients include-
1.Defer antiretroviral therapy until TB
treatment is completed.
2.Defer HAART until the end of initial phase
of treatment and use Isoniazide and
Ethambutol.
3.Treat TB with a Rifampicin containing
regimen and use Efavirenz +2NRTIS
4.Treat TB with a Rifampicin containing
regimen and use 2NRTIS;then change to
maximally suppressive HAART regimen on
completion of TB treatment