• Tuberculosis is a chronic
granulomatous disease caused by
• A major health problem in developing
Aims of treatment
• To kill the dividing bacilli & to destroy the
persisters in order to prevent relapse and
ensure complete cure
To prevent development of drug resistance.
To decrease transmission to others.
Drugs are combined to:
• Delay the development of resistance
• Reduce toxicity
• Shorten the course of treatment
Duration of therapy: Depends on
1.Site of disease,
3.Severity of disease,
4.History of treatment and resistance.
1. First line antitubercular drugs (standard drugs)
• Isoniazid (H)
• Rifampicin (R)
• Pyrazinamide (Z)
• Ethambutol (E)
• Streptomycin (S)
First line antitubercular drugs
ISONIAZID (Isonicotinic acid hydrazide, INH)
• Mechanism: inhibits the biosynthesis of
mycolic acids, which are essential constituents
of the mycobacterial cell wall
• Hepatitis - loss of appetite, nausea, vomiting,
jaundice, and right upper quadrant pain
• Peripheral neuropathy (deficiency of
• Fever, skin rashes , arthralgia, GI disturbances
• Psychosis, optic neuritis and rarely
• Flu-like syndrome – fever, chills, headache,
muscle & joint pain
• GI disturbances
• Skin rashes, itching, & flushing
• Orange-red discoloration of body fluid
secretions such as urine, tears, saliva, sweat,
sputum etc - patient to be informed
• Inhibits arabinosyl transferases that are
involved in mycobacterial cell wall synthesis
• Optic neuritis: red -green color blindness
• Skin rashes & joint pain
•Like INH, pyrazinamide inhibits mycolic acid
biosynthesis but by a different mechanism.
Adverse effects :
•Anorexia, nausea, vomiting, fever and skin
• It was the first effective drug developed for the
treatment of tuberculosis.
• Is an aminoglycoside antibiotic
• Adverse effects: ototoxicity, nephrotoxicity
and neuromuscular blockade
In case of resistance to first-line agents
In case of failure of clinical response to
In case of serious treatment limiting adverse
Treatment of Tuberculosis:
• WHO recommends the use of multidrug
therapy (MDT) for all cases of tuberculosis.
The objectives of MDT are:
– To make the patient non-infectious as early as
possible by rapidly killing the dividing bacilli by
using 3-4 bactericidal drugs.
– To prevent the development of drug resistant
– To prevent relapse by killing the persisters or
– To reduce the total duration of effective therapy.
Short Course Chemotherapy (SCC)
• Tuberculocidal drugs used
• The main objective is to render the patient
• This phase helps to eliminate persisters and
Use : antileprotic agent
Haemolytic anemia & methaemoglobinaemia – G6PD
Sulfone syndrome – fever, dermatitis, pruritus, anemia
lymphadenopathy & hepatitis
GI disturbances, headache, itching
2. Rifampicin – used in multidrug regimens – kills most
of the bacilli
MOA – binds to mycobacterial DNA - inhibits its
– anti-inflammatory effect
Use : antileprotic agent
Accumulates in tissues : red-to-brown discoloration
of the skin
Pigmentation of the conjunctiva & cornea
Treatment of Leprosy
Paucibacillary :- Dapsone:100mg daily
Rifampin:600mg once a month-Supervised.
Duration:- 6 months.
Dapsone:- 100mg daily
Rifampin:- 600mg once a month supervised
Clofazimine:- 300mg once a month supervised,50 mg
Duration:- 24 Months.