Download Chapter 48 Antidysrhythmic Drugs

Chapter 86
Antimycobacterial
Agents: Drugs for
Tuberculosis, Leprosy,
and Mycobacterium avium
Complex Infections
Copyright (c) 2004 Elsevier Inc. All rights reserved.
Antimycobacterial Agents: Drugs for
Tuberculosis, Leprosy, and Mycobacterium
avium Complex Infections
• Tuberculosis
– Mycobacterium tuberculosis
– Person to person
– Inhaled infected aerosol
• Screening
– Tuberculin skin test (PPD)
• Diagnosis
– Cytology
– Chest x-ray
Copyright (c) 2004 Elsevier Inc. All rights reserved.
Drug Resistance With
Tuberculosis
• Goal of treatment
– Eliminate symptoms
– Prevent relapse
• Drug resistance
– Contact—person with resistant TB
– Repeated effectual courses of treatment
Copyright (c) 2004 Elsevier Inc. All rights reserved.
Causes of Drug Resistance
Principal cause underlying the emergence of resistance is
inadequate drug therapy
Copyright (c) 2004 Elsevier Inc. All rights reserved.
Treatment Regimens for
Tuberculosis
• Two phases
– Induction phases
• Eliminate active tubercle bacilli
– Continuation phase
• Eliminate intracellular “persisters”
Copyright (c) 2004 Elsevier Inc. All rights reserved.
Drug-Sensitive Regimen for
Tuberculosis
• Induction phase
2 months
• Daily therapy
– Isoniazid
– Rifampin
– Pyrazinamide
– Ethambutol
Copyright (c) 2004 Elsevier Inc. All rights reserved.
• Continuation phase
4 months
• Daily or biweekly
– Isoniazid
– Rifampin
Multidrug-Resistant Regimen
for Tuberculosis
• Define
– Resistance isoniazid
and rifampin
• Treatment
– Three drugs for 1 to 2 yrs
• Initial therapy
– Isoniazid, Rifampin,
Pyrazinamide,Ethambutol,
Streptomycin
Copyright (c) 2004 Elsevier Inc. All rights reserved.
Isoniazid (Laniazid) (INH)
• Primary agent
• Bactericidal
• Adverse effects
– Peripheral neuropathy (pyridoxine vitamin
B6 )
– Hepatotoxicity
– Optic neuritis
– Anemia
Copyright (c) 2004 Elsevier Inc. All rights reserved.
Rifampin (Rifadin)
• Broad spectrum antibiotic
• Uses
– Tuberculosis
– Leprosy
– Haemophilus influenzae
– Legionella
• Adverse effects
– Hepatitis
– Discoloration of body fluids
Copyright (c) 2004 Elsevier Inc. All rights reserved.
Rifampin (Rifadin) (cont.)
• Drug interaction
– Oral contraceptives
– Warfarin
– Drugs for HIV infection
Copyright (c) 2004 Elsevier Inc. All rights reserved.
Ethambutol (Myambutol)
• Bacteriostatic
• Uses: tuberculosis
• Adverse effects
– Optic neuritis
– Allergy
– Hyperuricemia
Copyright (c) 2004 Elsevier Inc. All rights reserved.
Mycobacterium avium Complex
Infection
• Mycobacterium avium complex
– M. avium
– M. intracellulare
• Prophylaxis
– Azithromycin
– Clarithromycin
• Acute infection
– Same as prophylaxis plus ethambutol
Copyright (c) 2004 Elsevier Inc. All rights reserved.