Primary Complex Thread 2

[rhylie10]

goodeve po dra lelet, eto nanaman po ako, hehe..just got home po and nabanggit ko po sa inyo na pina-skin test ko din po anak ko kahapon, and bukas po ng umaga ang result, dadalin ko po siya sa pedia para makita yung inenject sa kanya, kasi po ngayon po itim siya and maliit lang po, parang half lang 10cents na coin, or di pa po aabot ng half nun..diba po pag malaki is positive, so kung ganun lang po kaliit yung size nun at itim po siya is there a posibility na negative siya sa skin test? pero yung sa pedia-pulmo niya nung monday sa x-ray palang daw po meron na at niresetahan na siya ng pedia kit, so ano po ba mas accurate talaga dun? what if negative siya sa skin test bukas, susundin ko pa din po ba yung sa pedia-pulmo na painumin nung hrz pedia kit (3 meds po diba?) sensya na o dami tanong..nalilito lang po talaga ako kung ano ba talag mas accurate, and yung sa pedia pulmo nasabi niyang meron nga po sa x-ray which is ang nakalagay na impression bilateral pneumonia w/ lymphadenopathy.. ano po icoconsider ko? yung negative na skin test or yung sa pedia pulmo na painumin ng pdia kit?? thanks po..sensya na po

[leletmd]

@rhylie10:
As I mentioned before, the Ppd skin test will only show exposure and not actual disease. A negative Ppd test doesnt mean na wala syang TB. You need a chest xray to diagnose Pulmonary TB.
There are times na hindi na pinapagawa ang Ppd kung meron na na actual source.
Sa ppd skin test, yung induration ang minimeasure (eto yung matambok na part) at hindi kasama sa measurement ang pula or redness. Ang valid na measurement is yung ginawa at 48 - 72 hours.
Pasensya na, I cannot make the decision for you. Did the pedia read the chest xray plates?
If you are still unsure, why not do a repeat chest xray?
 If the hilar lumphadenopathy is still there despite treatment with antibiotics, then there is a possibility that the pedia pulmo is right and your child indeed has TB.

@ankyneMD:
There is no harm in extending as long as there is proper basis for extending meds.

[ankyneMD]

thanks again dra. Lelet sana po gumaling na baby ko

[rhylie10]

thanks po, positive po siya sa skin test, kanina po 12mm daw sukat sabi nung gen.pedia, 6 months medication nga po, ang reseta po niya is kidz kit 3, yung sa pedia pulmo is hrz pedia kit, yung hrz na po papainom ko po kasi yun na po una kong nabili before pa gawin yung ppd test, same din naman po diba?  yung sa pedia-pulmo yung dosage po ng gamot niya sa isoniazid po yta yun and yung rifampacin  is 3.5 ml and pwede daw po imix, yung kanina naman po sa gen.pedia ang dosage po niya is isoniazid is 3 ml then rifampacin is 5 ml..magkaiba po??t

[arwen_00254]

Hi doc lelet! First time ko po magpost dito, Tanong ko lang po Doc lelet, I was diagnosed with mild PTB last jan. and started taking meds. last jan. 14, and after knowing po na I have PTB, pinachekup ko rin po ang 4yrs old daughter ko that time, the pedia advise to have a skin test, the result is 4mm, negative daw po but still pinatake pa rin ng medicine for prevention daw po. Ripampicin for 1 month and after a month pinalitan nya po ng Izoniazid 2.5ml until now, 3 months napo siya nagtake ng meds., ang sabi ng pedia nya, magstop lang daw po magtake ng med. ang daughter ko kapag tapos na rin daw po ang pagtake ko ng gamot and mag-end ako po sa july.14, ask ko lang po doc. Pwede na po ba stop ang med. ng anak ko since negative naman po at wala naman pong symptoms? Tama po bang hindi na nagpaxray test ang pedia nya? Tnx doc lelet!

[leletmd]

@rhylie10:
Same lang ang mg/kg ng isoniazid and rifampicin as far as I know so I would have to agree with the pedia pulmo regarding the dosage for isoniazid and rifampcin being the same. I do not recommend mixing any medications together but the 2 medications may be given one after the other. Please make sure that the 2 meds are given on an empty stomach and wait for 30 minutes to 1 hour before feeding your child for better absorption.

[rhylie10]

thanks po dra. lelet, nag start na po siya sa gamut nung Saturday, yung dosage po na sinabi ng pedia pulmo ang sinunod ko, 3.5ml sa comprilex and rimaped empty stomach every morning, then yung zinaplex po is after dinner ko po binibigay..thanks po

[myjoy]

dra. lelet, magtatanong po ulet ako. my son is on his 4th month na ng paggagamot ngayon. his first three months, he was given hrz pedia kit. the other day, binalik ko sya sa pedia for a follow up chack up kasi 4th month na nya. he was prescribed hr pedia kit. ang concern ko po, nagulat yung doctor na 3 months uminom ng hrz yung baby ko. dapat daw 2 months lang yung pyrazinamide pero sya naman mismo yung nagprescribe nun. every month ko naman dinadala si baby for a follow up check up and i still have the prescription na binigay nya sa akin. nung nalaman nyang ganon ang nangyari, sinabi nya lang na ok lang daw yun. hindi po ba masama na uminom ng isang buong buwan ng pyrazinamide si baby kahit na hindi na pala kailangan yun. thank you po dra.

[leletmd]

@myjoy:
2 months lang ibinibigay ang Pyrazinamide but there is no harm in extending it for little while. When you went back for the 3rd month check up, what was your pedia's comment regarding the medications? Dapat sana kasi napatigil na ang pyrazinamide by then...

@arwen_00254:
Sorry did not see your post.
Your child qualifies as having PTB exposure due to your having actual PTB, even if it is just mild PTB so talagang dapat magtake siya ng Isoniazid with or without Rifampicin (Rifampicin is added if there is risk of drug resistance with just Isoniazid alone) even if PPD is negative. In my opinion, a chest xray also should have been done to determine if there is actual disease na. What was the reason why a chest x-ray was not done during the time that you brought your child for check up?

[rhylie10]

good morning po, hi dra. lelet, eto nanaman po ako, tatanong po ulit, yung pedia po ng anak ko sabi painumin ko daw po ng MOSEGOR syrup for kids yung daughter ko, ok lang po ba yun kahit nagtetake yung anak ko ng HRZ PEDIA KIT? nag start po sya ng anti-tb meds nung june 15, vitamins po niya ngayon is clusivol and ceelin, ehh hina po talaga kumain ng anak ko, as in isang subo lang po talaga, kahit anong ulam ayaw, sabi po ng pedia niya stop ko muna daw po yung clusivol, MOSEGOR daw po palit ko, ok lang po ba yun kahit nagtetake siya ng HRZ pedia kit? la po bang side effect yun? thanks po.. god bless

[midphantom]

hello po dra lelet..makikisali rin po ako.. my son was also diagnosed with pc.. ask ko naman po kc may g6pd po sya.. di ba po bawal yung isoniazid sa may g6pd? ang ginawa po ng pedia nya,hindi na lang sinama yun sa mga iniinom nya.. bale yung rifamficin at pyrazinamide lang..tpos pinaiinom din sya ng carbocistein.. ok lang po ba talaga na hindi na isali yung isoniazid? may gamot po ba na pwedeng ipalit dun? kc kung hindi ibibigay yun bka hindi naman gumaling yung anak ko.. saka ok ln po ba na kasabay yung carbocistein? cenxa napo ang dami ko tanong..
thank you po in advance..

[puglover]

hi Dra.. yun Zcure from the kidzkit3 forte.. automatic ba siya na for 3 months lang or depends on the severity of the primary complex? 2 kasi pedia namin. Yun pedia pulmo said 4 months while the other, yun naka diagnose sa kanya, said 3 months lang daw. how bad kung masobrahan sa Zcure? Also she said babaan na dosage from 4ml to 3ml nalang. Wala naman weight loss. Thamks dra

[leletmd]

@rhylie10:
Mosegor syrup or mosegor vita syrup? Some physicians kasi give Mosegor vita sryup while patients are on TB meds as an appetite stimulant. It is basically pizotifen plus B complex vitamins. Side effects include sedation, dryness of the mouth, etc, but may also cause irritability in kids.

@midphantom:
Isoniazid is actually a low risk drug for G6PD patients, but I guess your pedia is just being cautious and doesn't want your child having a reaction since the medication has to be given for at least 6 months.
Yes, there are alternatives to giving isoniazid for TB, like streptomycin (given as an injection so not ideal for kids) and ethambutol (not given for kids less than 7 years of age since it affects vision of kids).
Rifampicin and pyrazinamide are very capable of killing the TB bacilli.
What is the reason daw for giving the carbocisteine and for how long is it suppose to be taken?

@puglover:
Ideally, pyrazinamide should be given for 2 months while Isoniazid and rifampicin should be given for at least 6 months. There are special cases wherein the meds are extended. Did the 2 pedias explain as to why they want to extend use of pyrazinamide? The best thing to do is to clarify it with them...

[rhylie10]

good am po  dra lelet, thanks for the reply, wala pong reseta yung pedia, tinext lang po ako na bigyan ko daw po ng mosegor yung daughter ko kasi nga po tinext ko po na mahina talaga kumain, then bumili po ako sa mercury sabi ko po mosegor na pambata, ang binigay po sakin is yung white ang box, may vita syrup po yata nakalagay sa sa box and b-complex, nakabili na po ako pero di ko pa po napainom kasi wait parin po ko reply niyo, hehe..kahit sinabihan po ako ng pedia nya ask pa din po ako sa inyo, so kung yung nabili ko po may nakalagay ng VITA SYRUP w/ B-COMPLEX ok lang po painom while on anti TB Meds?? thanks po.. will wait for your reply again..god bless po

[yang]

hello! my pamangkins on my husbands side. 2 boys were treated before with TB meds i remember it was in pack of 3 bots.
i understood it should be monitored and closely ff up. but after a while hindi na tinuloy nun mother nila yun medication. because the kids cants take it anymore,
and that they were feeling alot better na daw accdg to my SIL. last sunday, i noticed the eldest child still have palpable lymphnode although it already decreased in size but
it is still very prominent. Im just worried about the health of these kids. im a soon to be mom, i just felt these kids health is being neglected.

[leletmd]

@yang:
Best to clarify with your SIL if the 2 kids did have PC. If yes, please ask if they were able to complete at least 6 months of treatment and if they were able to find out who the source of the PC was. This is essential since you have a baby on the way and if they have not found the source or the source has not had any treatment, then your baby will also be at risk later on.

@rhylie10:
Mosegor vita may be given together with the PC meds, but please monitor for side effects such as hyperactivity or irritability. Also, I do not recommend giving appetite stimulants for a long period of time so once appetite has improved, please ask your pedia if it is okay to switch back to clusivol.
Please don't forget that it is important to bring your child back to the pedia for their monthly follow ups while on PC meds to monitor for reactions as well as progress.

[Tobeyrich]

@ doc lelet, ask ko lang po, nung nag start mag gamot for PC si baby, binigyan din siya ng pedia niya ng Propan Syrup although magana naman na siya kumain, napansin ko na within a month na pag inom niya ng propan syrup nagdoble ang lakas nya kumain, namumutok na [textspeak!] tiyan niya. Mga how long po siya mag propan syrup? This thursday pa po kasi [textspeak!] next check up niya kaya lang medyo nag wworry ako at sobra lakas kumain, miyat miya ang kain niya ng cookies, rice, and milk. Does it mean din po ba na maganda ang effect ng PC meds niya as early as his first month pof taking it?

Thanks po in advance

[rhylie10]

thanks po for the reply, yes po mosegor vita nga po yung nabili ko, yung pedia pulmo po niya ang sinabi po niya is clusivol nga po and ceelin, then yung isang pedia nya po sya po yung nagsabi ng mosegor,follow up check niya po will be on july 10, nakakatakot naman po kasi yung mosegor kasi may nabasa nga po ako may side effects daw po, meron aman nagsabi ganda ng effect sa mga babies nila tumaba daw at talagang tumakaw, ang milk po niya ngayon is gain plus adv and pediasure choco, dinagdagan po naming ng pediasure kasi po pag di po siya kumain ng isang meal yun po ang sub namin, I realized last night na di aman tlaga dapat lagi nalang umasa sa appetite stimulant, tyagaan lang talaga, kasi po kagabi ayaw kumain ng anak ko pero dami kong kwento as in binolabola ko naubos niya yung monggo na may malunggay at rice, pero saying yung mosegor mahal pa aman, maliit lang po yun 60 ml, pwede po paubos ko yun then balik ko nalng sa clusivol? dati ayaw niya kumain ng carrots, pero nung kinuwentuhan ko siya about carrots kunwari na gaganda mata niya, ayun kumain siya nung isang gabi, hehe,,kakatuwa nga po eh..talagang tyagaan lang, kaso sa morning and lunch nsa work ako kaya di ko po namomonitor pagkain niya..

[rhylie10]

ang problem ko po talaga sa pagkain niya is kahit anong prutas po talaga di ko siya mapakain, kahit apple or orange ayaw po talaga kahit nung baby pa siya, wala po siyang prutas na nakakain, and mga juices ayaw niya po talaga..haisst;(

[yang]

dra, my nephews didnt proceed nor had a ff-up. kasi daw nagpula yun bata accdg to my SIL. so basically, wala talagang nangyari.
mahahabol pa ba ito? then, i ask san sila na expose. she answered siya and her husband and the yaya lang ang kasama sa bahay she claimed, theyre all well.