Correct!
1. Begin 4 drug therapy while awaiting culture and sensitivity results

The chemotherapy for tuberculous pleuritis is the same as that for pulmonary tuberculosis. Initially 4 drugs are recommended (isoniazid (INH), rifampin, pyrazinamide and ethambutol) until the results of drug susceptibility studies are available. Drug resistance is more frequent in India than the US but still only constitutes 1-2% of tuberculosis cases (3). Corticosteroids are controversial. Most only give corticosteroids only for severe pain (2).

Our patient was given 4 drugs and rapidly improved. His cultures were eventually positive and revealed drug-sensitive tuberculosis. He is presently receiving therapy with INH and rifampin and a 6 month total course with directly observed therapy is planned.

References

1. Diel R, Goletti D, Ferrara G, et al. Interferon-γ release assays for the diagnosis of latent Mycobacterium tuberculosis infection: a systematic review and meta-analysis. Eur Respir J. 2011 Jan;37(1):88-99. [CrossRef] [PubMed]
2. Light RW. Update on tuberculous pleural effusion. Respirology 2010 Apr;15(3):451-8. [CrossRef] [PubMed]
3. Institute of Medicine (US). Facing the Reality of Drug-Resistant Tuberculosis in India: Challenges and Potential Solutions: Summary of a Joint Workshop by the Institute of Medicine, the Indian National Science Academy, and the Indian Council of Medical Research. Washington (DC): National Academies Press (US); 2012. Available at: https://www.ncbi.nlm.nih.gov/books/NBK100386/ (accessed 11/25/16).

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