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Pyridoxine Dose Adjustment TB — SCE Infectious Diseases MCQ

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EasyTuberculosisPyridoxine Dose Adjustment TBSCE Infectious Diseases

A 55-year-old man with TB develops peripheral neuropathy. He is on standard RHZE plus Pyridoxine 10 mg daily. Despite Pyridoxine, his neuropathy worsens. What should be considered?

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Correct answer: D — Increase Pyridoxine dose to 50–100 mg daily

Isoniazid causes peripheral neuropathy through pyridoxine depletion. Standard Pyridoxine 10 mg daily prevents neuropathy in most patients, but some require higher doses (25–50 mg daily), particularly those with risk factors: diabetes, malnutrition, HIV, alcohol excess, renal impairment. Ethambutol can also contribute to peripheral (and optic) neuropathy. If neuropathy develops despite standard Pyridoxine, increase the dose and assess whether Ethambutol may be contributing.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections