What are the brand names and doses of medications for a patient with abdominal tuberculosis, including those with impaired renal function or severe hepatic disease?

Brand Names and Doses for Abdominal Tuberculosis

Standard First-Line Regimen

For abdominal tuberculosis, the standard 6-month regimen is equally effective as longer regimens and should be used with the following medications and doses 1, 2, 3:

Intensive Phase (First 2 Months)

Brand Names:

• Rifamate®: Contains Rifampin 300 mg + Isoniazid 150 mg per capsule 1
• Rifater®: Contains Rifampin 120 mg + Isoniazid 50 mg + Pyrazinamide 300 mg per tablet 1

Daily Dosing for Adults:

• Isoniazid: 5 mg/kg (typically 300 mg) daily 1
• Rifampin: 10 mg/kg (typically 600 mg) daily 1, 4
• Pyrazinamide: 10-20 mg/kg daily 1
• Ethambutol: 15 mg/kg daily (initial treatment) 1, 5

Using Rifater® (weight-based):

• ≤44 kg: 4 tablets daily
• 45-54 kg: 5 tablets daily
• ≥55 kg: 6 tablets daily 1
• For patients >90 kg, additional pyrazinamide tablets must be added 1

Continuation Phase (Months 3-6)

Using Rifamate®:

• 2 capsules daily (600 mg rifampin + 300 mg isoniazid) 1

Or individual drugs:

• Isoniazid: 5 mg/kg (typically 300 mg) daily 1
• Rifampin: 10 mg/kg (typically 600 mg) daily 1, 4

Pyridoxine Supplementation

Vitamin B6 (Pyridoxine): 25-50 mg daily should be given with isoniazid to all patients at risk of neuropathy, including those with diabetes, alcoholism, malnutrition, chronic renal failure, or advanced age 1

Special Populations

Impaired Renal Function

For patients with renal insufficiency 1:

• Rifampin, Isoniazid, Pyrazinamide: Can be given at standard doses 1
• Ethambutol: Requires dose reduction and serum concentration monitoring 1
  • Retreatment dose: 25 mg/kg initially, then reduce to 15 mg/kg after 60 days with monthly eye examinations 5
  • Should NOT use Rifater® due to need for pyrazinamide dose adjustment 1
• Rifamate®: May be used without dose adjustment 1

For creatinine clearance <50 mL/min:

• Avoid ethambutol unless absolutely necessary with careful monitoring 1
• Cycloserine should not be used 1

For hemodialysis patients:

• Administer all drugs after dialysis 1
• Monitor serum drug concentrations for ethambutol and cycloserine 1

Severe Hepatic Disease

For patients with severe liver disease 1:

• DO NOT use fixed-dose combinations (Rifamate® or Rifater®) until safety is established 1
• Use single-drug formulations initially with frequent monitoring 1
• Baseline and weekly liver function tests for first 2 weeks, then every 2 weeks for first 2 months 1

Alternative regimens if AST >3× normal:

• Option 1: Rifampin + Ethambutol + Pyrazinamide for 6 months (avoiding isoniazid) 1
• Option 2: Isoniazid + Rifampin for 9 months, supplemented by ethambutol until susceptibility confirmed (avoiding pyrazinamide) 1
• Option 3: For severe disease, Rifampin + Ethambutol for 12 months, preferably with fluoroquinolone for first 2 months 1

Stop all hepatotoxic drugs immediately if:

• AST/ALT ≥3× upper limit of normal WITH symptoms 6
• AST/ALT ≥5× upper limit of normal WITHOUT symptoms 6
• Any bilirubin elevation above normal 6

Pediatric Dosing

Daily regimen for children 1:

• Isoniazid: 10-15 mg/kg daily
• Rifampin: 10-20 mg/kg daily
• Pyrazinamide: 10-20 mg/kg daily
• Ethambutol: 15 mg/kg daily (not recommended under 13 years due to inability to monitor visual acuity) 5

Critical Monitoring

Baseline testing required for high-risk patients 4, 6:

• Liver function tests (AST, ALT, bilirubin) for those with pre-existing liver disease, HIV, pregnancy/postpartum, alcohol use, or concurrent hepatotoxic medications 4, 6
• Visual acuity documentation if using ethambutol 4

Monthly monitoring 4:

• Clinical evaluation for fever, malaise, vomiting, jaundice
• Orange/pink urine discoloration as compliance indicator for rifampin 4