Antituberculosis treatment (active tuberculosis): tests and monitoring

Laboratory tests

• AST
• ALT
• Bilirubin
• Alkaline phosphatase
• Serum creatinine with eGFR
• Serum urate
• Serum sodium (electrolytes)
• FBC with platelets
• HIV serology
• Hepatitis B serology (HBsAg, anti-HBs, anti-HBc)To be offered routinely as part of ALD 29 (long-term condition, France) ^[2]; the ATS reserves them for at-risk patients (injecting drug use, birth in Africa or Asia, HIV infection) ^[3]. Viral hepatitis increases the risk of drug-induced hepatitis and justifies liver monitoring beyond the initial work-up ^[3].
• Hepatitis C serologyTo be offered routinely as part of ALD 29 (long-term condition, France) ^[2]; the ATS reserves them for at-risk patients (injecting drug use, birth in Africa or Asia, HIV infection) ^[3]. Viral hepatitis increases the risk of drug-induced hepatitis and justifies liver monitoring beyond the initial work-up ^[3].
• Fasting plasma glucose or HbA1c (risk factor for diabetes)if needednon-French guidelineLooking for diabetes in at-risk patients (age > 45 years, BMI > 25 kg/m², first-degree relative with diabetes, certain origins) ^[3].
• β-hCG (woman of childbearing potential)if neededWoman of childbearing potential: pregnancy test before rifampicin (SmPC) ^[4]; “optional” in the HAS ALD 29 list ^[2]. Effective non-hormonal contraception during treatment, and for 6 months afterwards on pyrazinamide ^[4,5].
• Not a laboratory test: ophthalmological examination before ethambutol (acuity, visual field, colour vision, fundus); microbiological tests and X-ray according to the specialist.

Every week for the first 2 months (phase with pyrazinamide)

• AST
• ALT

On day 8 and at the end of the first month

• FBC with platelets

Then every month until the end of treatment

• AST
• ALT
• Serum creatinine with eGFR
• Serum urate (as long as pyrazinamide is taken)
• FBC (with platelets), every 2 months

• See the page “Latent tuberculosis infection” (screening, tests before treatment and liver monitoring).