Download Isoniazid

PRINCIPLES AND METHODS OF
TUBERCULOSIS THERAPY
The main principles of tuberculosis therapy
are the following ones:
-
-
chapter covers the basic principles in the
chemotherapy for tuberculosis. Current drug
regimens recommended in the American
Thoracic Society and Center for Disease
Control and Prevention Statement' are
presented. Special attention is given to drug
interactions and intolerances. Issues
specifically regarding HIV, multidrug
resistant tuberculosis (MDR-TB), and
nontuberculous (atypical) mycobacteria are
covered in greater detail in other chapters.
ORGANISM CHARACTERISTICS
stopped. Bactericidal drugs should be used
whenever possible. Drug regimens with two
or more bactericidal drugs, including RIF,
should be used when possible because this
regimen results in the lowest relapse rates.
However, drug resistance, intolerance, or
drug interactions can make the use of two
bactericidal drugs impossible. In these cases,
it is necessary to add multiple bacteriostatic
agents and treat for longer periods of time.
• Actively Growing Extracellular Organisms
DEVELOPMENT OF DRUG
RESISTANCE
ADHERENCE TO THERAPY
• DRUGS
• First-Line Drugs
Isoniazid
Liver function tests if baseline results
are abnormal or if symptoms of adverse
reactions occur Pyrazinamide
Abnormal results for liver function
tests; rash; gout Stomach upset; joint
aches Liver function tests if baseline
results are abnormal or if symptoms of
adverse reactions occur; uric acid if joint
symptoms occur Ethambutol
Damage to the optic nerve; elevation
of uric acidChanges in vision and color
Rifampin
Pyrazinamide
Ethambutol
Streptomycin
Second-Line Drugs
Rifabutin
Ethionamide
Cycloserine
Para-Aminosalicylic Acid
Clofazamine
Aminoglycosides other than Streptomycin
Quinolones
Experimental Drugs—Rifapentene
Drug Regimens
Treatment Regimens
Drug Interactions
Drug Intolerance
TABLE 4. Drug Interactions
Isoniazid Alternative Routes of
Administration
Interruption of Therapy
Monitoring Drug Levels
Special Situations
Drug-Resistant Tuberculosis
Extrapulmonary Tuberculosis
therapy, however. It is often more difficult to
obtain tissue specimens for smear and culture
from patients with extrapulmonary disease.
Surgery may be necessary to obtain
diagnostic specimens in some circumstances,
such as constrictive pericarditis or spinal
tuberculosis.
Corticosteroids
Immune Deficiency States
Treatment in Children
Pregnancy and Lactation
Renal Dysfunction
Drug Adjustment for Glomerular
Filtration Rate (ml/min)
Isoniazid
Liver Dysfunction
Malabsorptive States
References
• 4. Tsukamura M: In vitro antituberculosis activity of a new
antibacterial substance ofloxacin (DL8280). Am J Respir Dis
1985;131:349-351.