A 30-year-old man with sputum-positive pulmonary tuberculosis is started on standard first-line antitubercular therapy. After 2 weeks, he develops numbness and tingling in both feet. Which of the following is the most appropriate next step in management?

• A Stop isoniazid immediately
• B Add carbamazepine
• C Switch to second-line antitubercular drugs
• D Add pyridoxine supplementation ✓

Explanation

Isoniazid interferes with pyridoxine metabolism, causing peripheral neuropathy. The correct management is to add pyridoxine 10 to 50 mg daily while continuing antitubercular therapy. Stopping isoniazid is unnecessary unless symptoms are severe. The most tempting distractor is stopping isoniazid, but treatment interruption risks resistance and relapse.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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