the Risks of Tuberculosis Treatment in Elderly Patients

Q: the Risks of Tuberculosis Treatment in Elderly Patients

Hello： Thank you for your reply! There are indeed many cases of pulmonary tuberculosis associated with hemoptysis, and the additional anti-tuberculosis medications are not related to the bleeding (no specific anti-tuberculosis medication has been mentioned to carry a risk of blee

Regarding tuberculosis, thank you Dr. Yang for your response?

Thank you, Dr.
Yang, for taking the time to respond amidst your busy schedule.
My grandfather, who was originally in the isolation ward, was transferred to a general ward last Wednesday, the 19th, after starting medication without any rejection or infectiousness.
We are waiting for his health status check report, and the hospital estimates that he should be discharged next Monday, the 24th, to continue taking tuberculosis medication for an expected duration of nine months.
It may have been well-intentioned or perhaps an experimental approach, but it is unclear.
The attending physician increased the originally prescribed nine-month medication by one additional pill, planning for a six-month course.
Coincidentally, last Saturday, the 22nd, he developed a cough with blood, and his condition rapidly deteriorated, leading to his transfer to the intensive care unit.
Despite receiving inotropic support in the ICU, there was no improvement, and due to age-related organ damage, no further interventions were possible.
He passed away on Sunday, the 23rd.

Is it possible that the additional medication caused this? We do not know.
As a layperson without medical training, I find this situation perplexing: does tuberculosis medication save or harm elderly patients? My grandfather had non-open pulmonary tuberculosis, with no symptoms of cough or sneezing.
In late August, he had three sputum cultures, with only one returning positive.
Why was he not subjected to further testing before starting treatment? Is this preventive medication or merely a form of treatment? As a family member, I have my doubts.
A quick search on Google reveals numerous cases of medication errors, which I believe is just the tip of the iceberg.
My grandmother, over a decade ago, had persistent coughing with no identifiable cause.
Doctors assumed it was tuberculosis and prescribed medication.
She reported extreme discomfort after starting the treatment, and two months later, it was discovered that she actually had lung cancer.
Is this a misdiagnosis? Or is it simply a regrettable case of preventive medication? The former is a diagnostic error, while the latter can only be accepted as such.

I hope that in the future, there will be more comprehensive methods and protocols to accurately determine whether a patient is infected with tuberculosis, and to administer medication with greater caution to prevent similar incidents from occurring.
Thank you, Dr.
Yang, and I wish you all the best.

Xiao Xie, 20~29 year old female. Ask Date: 2016/10/25

Dr. Yang Wenda reply Pulmonology

Hello: Thank you for your reply! There are indeed many cases of pulmonary tuberculosis associated with hemoptysis, and the additional anti-tuberculosis medications are not related to the bleeding (no specific anti-tuberculosis medication has been mentioned to carry a risk of bleeding).
The physician's role is to treat patients, and the clinical condition of patients can vary significantly, making it sometimes difficult to reach a clear diagnosis in a short period.
Let's continue to support our healthcare professionals! Thank you! Wishing you well!

Reply Date: 2016/10/25

More Info

Understanding the risks of tuberculosis (TB) treatment in elderly patients is a complex issue that requires careful consideration of both the benefits and potential adverse effects of the medications involved. Tuberculosis, particularly in its active form, can be a life-threatening condition, especially in older adults who may have multiple comorbidities. However, the treatment itself can also pose significant risks, particularly due to the side effects of the medications used and the overall health status of the patient.

In the case of your grandfather, who was diagnosed with non-open pulmonary tuberculosis, the decision to initiate treatment was likely based on the need to manage the infection effectively. TB treatment typically involves a combination of antibiotics over an extended period, usually six to nine months, depending on the specific circumstances. The medications used, such as isoniazid, rifampicin, pyrazinamide, and ethambutol, can have side effects that may be more pronounced in elderly patients. These can include liver toxicity, gastrointestinal disturbances, and hematological issues, among others.

The unfortunate turn of events following the adjustment of your grandfather's medication regimen raises several important points. First, the addition of an extra medication may have contributed to his decline, but it is essential to understand that the relationship between medication changes and adverse outcomes is not always straightforward. Elderly patients often have diminished physiological reserves, making them more susceptible to complications from both the disease and its treatment. The presence of other underlying health issues, such as heart disease or chronic obstructive pulmonary disease (COPD), can further complicate the clinical picture.

Moreover, the decision to treat TB, especially in older adults, must weigh the risks of the disease against the potential risks of treatment. In some cases, if the TB is not causing significant symptoms or if the patient is stable, a more conservative approach of monitoring may be considered. However, this must be balanced against the risk of disease progression and transmission.

Your concerns about the potential for misdiagnosis and the appropriateness of treatment protocols are valid. The medical community is continually striving to improve diagnostic accuracy and treatment protocols to minimize the risk of adverse outcomes. In cases where there is uncertainty about a diagnosis, further testing and consultation with specialists can be crucial.
In conclusion, while tuberculosis treatment can be life-saving, particularly in older adults, it is not without risks. The decision to initiate or modify treatment should always involve a thorough assessment of the patient's overall health, potential drug interactions, and the specific characteristics of the TB infection. Open communication with healthcare providers, including discussions about the risks and benefits of treatment options, is essential for making informed decisions. It is also important for families to advocate for their loved ones, ensuring that all concerns are addressed and that the treatment plan is tailored to the individual's needs.

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