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17 Cards in this Set

  • Front
  • Back
Therapy of Tuberculosis
-immunosuppressed patientshave increased incidence of TB
-long duration of therapy (6-24 months)
-intracellular pathogen grows slowly
-lesions within lung get walled off
-resistance to drugs developes readily
-all useful drugs possess toxicity problems
First Line Drugs for TB
-primary drug in all regimens, also prophylaxis
-excellent tuberculcidal drug, most rapid acting
useful for other bacterial infections
very effective with isoniazid
-Pyrazinamide and Streptomycin
used when resistance to above agents
Clinical Problems
of drugs
Isoniazid (peripheral neuritis, hepatitis)

Rifampin (hepatic toxicity and GI effects)

Ethambutol (altered visual acuity and and ability to peceive green)

Pyrazinamide (hepatic necrosis)

Streptomycin (ototoxicity, vestibular toxicity, and nephrotoxicity
-Mechansm of Action
inhibit synthesis of mycolic acid & DNA synthesis
static (resting bacilli), cidal (growing bacilli)
peripheral neurtitis due to inactivation and depletion of pyridoxine by reaction with isoniazid
hepatitis (especially above age 35)(covalent binding of reactive metabolite in liver)
hypersensitivity reactions
inhibit RNA polymerase)

-(sev. gram-pos. & gram-neg.)
-oral admin, excellent distribution , metabolized
-1-5 hrs
colors secretions (urine & tears) red-orange
-induces hepatic metabolism of other drugs
-GI distress, diarrhea,

-influenzae-like syndrome
considerations, why it is good
more rapid action in eliminating infectious state
-used in combination with isoniazid in uncomplicated cases, add other drugs if resistance
Rifampin Therapy
Non-tuberculosis therapy
3 things
-asymptomatic carriers and prophylaxis of N. meningitidis
-erythromycin-resistant Legionella
-combination with vancomycin for endocarditis or osteomyelitis due to methicillin-resistant staph.
-characteristic feature
-tuberulostatic so resistance if used alone
-good oral absorption and mainly eliminated by renal excretion
-decreased visual acuity
impaired ability to perceive green
-optic neuritis
-may precipitate gout
-General Features
aminoglycoside (same mechanism, limited distribution and toxicities

-vestibular toxicity
-General Features
-added if resistance problems or require three effective agents
-partially metabolized and excreted by renal glomerular filtration
pyrazinamide Toxicity
-liver necrosis
-nausea and vomiting
Chemoprophylaxis of TB
-Isoniazid is only TB drug proven effective for prophylaxis
-Rifampin being studied for prophylaxis when isoniazid cannot be used
-BCG vaccination recommended for infants and children with negative PPD
6 Candidates for Prophylaxis
-Individuals definitely infected (positive PPD) but no apparent disease
-History of disease that presently inactive
-Persons infected with HIV
-Drug users (esp. if IV admin.)
-Others at high risk (immunosuppressed)
-Individuals exposed to active TB but without evidence of infection
6 General Principles of TB Therapy
-Always use more than one agent
-Use agents to which bacteria are sensitive
-Isoniazid is usually primary agent, ethambutol or rifampin second if organism sensitive to all
-(may use 4 drugs initially until susceptibility determined, esp. in patients likely to have resistant organisms)
-Two drug regimens usually adequate if bacteria sensitive to both drugs which must be tuberculocidal
-Very serious as well as retreatment cases require 3 or 4 drugs
-3rd drug can be sensitive if any of first line drugs if organism is sensitive
4 Potentially effective TB drugs
2. Fluoroquinolones Ciprofloxacin, Levofloxacin, newer drugs tested
3. Rifamycin derivatives
Rifabutin and Rifapentine
4. Clofazimine
Summary of Clinical Problems of the 5 first line drugs
-Isoniazid (peripheral neuritis, hepatitis)
-Rifampin (hepatic toxicity and GI effects)
-Ethambutol (altered visual acuity and and ability to peceive green)
-Pyrazinamide (hepatic necrosis)
-Streptomycin (ototoxicity, vestibular toxicity, and nephrotoxicity