Hello sir, There is a patient whose diagnosis koch lungs (acute infection, in his blood report his creatinine level high 1.63 .normal range is .67 -1.17 so as such patient should start att directly or to lower down creatinine first please help me.

Creatinine is high what is the cause for that should be evaluated first. There is no hurry in iniating ATT. But of the patient is so sick of TB, then ATT should be initiated immediately. In such a case Ethambutol should be given on alternate day with complete dose. So it would be better to give ATT basing on an alternate day regime. Once creatinine becomes normal switch over to daily regime. 

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