TB DRUGS , CLASSIFICATIONS, TREATMENT.

1. ANTI-TUBERCULAR DRUGS
BY :- MANISHA KUMARI
IGIMS PATNA -14.

2. ANTI-TUBERCULAR DRUGS ARE USED TO TREAT
TUBERCULOSIS .
FIRST LINE DRUGS :-[HRZES]
1. H - ISONIAZID
2. R – RIFAMPICIN
3.Z – PYRAZINAMIDE
4.E – ETHAMBUTOL
5. S -STREPTOMYCIN

3. NOTES :-
. ETHAMBUTOL IS BACTERIOSTATIC, REST ALL
ARE BACTERIOCIDAL .
. PYRAZINAMIDE - AVOIDED IN PREG..
[INTRACELLULAR ]
. STERPTOMYCIN – C/I IN PREG .
[EXTRA CELLULAR ]

4. MYCOBACTERIA, LOCATION AND MOST EFFECTIVE
DRUGS:-
1. FAST GROWING- WALL –ISONIAZIDE [H]
2. INTERMEDIATE GROWING –CASSEOUS NECROSIS [SPURTERS ] –
RIFAMPICIN [R]
3. SLOW GROWING– I/C –PYRAZINAMIDE [Z]

5. 1. ISONIAZID [INH] :-
.IT CAUSES VIT- B6 DEF. [PYRIDOXINE DEF] , RESULTING IN
PERIPHERAL NEUROPATHY .
SO PYRIDOXINE IS USED FOR TRETMENT AS WELL AS
PREVENTION .
. HEPATOTOXIC
. METABOLISED BY acetylation , so cause sle as adverse effect.

6. 2. Rifampicin [r]:-
.given empty stomach.
.Secreted in bile – safe in rf
.enzyme inducer
.causes orange color urine
.staining of contact lens, due to discoloration of tear
.uses :- leprosy , doc for brucella, effective against
gnb [include pseudomonas ] , prophylaxis of
meningococcus meningitis

7. 3. Pyrazinamide [z]:-
. effective only against intracellular bacteria
. hepatotoxic
. hyperuricemia
. best sterilizing activity
. kill slow growing bact.
. Makes medium sterile .

8. 4. ETHAMBUTOL :-
. AFFECTS EYE
. RED GREEN COLOR BLINDNESS [OPTIC NEURITIS]
. AVOID IN < 6 YRS CHILDREN

9. 5. STREPTOMYCIN :-
. NOT GIVEN ORALLY , ONLY I.M .
. NEPHROTOXIC
. OTOTOXIC
. CAUSES NEURO-MUSCULAR BLOCKADE
. INITIALLY IT WAS FIRST LINE OF DRUG , AFTER THAT
SHIFTED TO SUPPLEMENTARY CATEGORY [AS IT NEEDS
TO BE GIVEN AS INJECTION ]

10. SECOND LINE OF DRUGS :-
1. FLOROQUINOLONE [FQ]
2. INJECTABLE
3. LINEZOLIDE
4. CYCLOSERINE
5. OTHERS

11. 1. FQ :- OFLOXACIN
MOXIFLOXACIN
GATIFLOXACIN
LEVOFLOXACIN
2. INJECTABLE :- CAPREOMYCIN
KANAMYCIN
AMIKACIN
3. LINEZOLIDE :- USED FOR VRSA
CLOFAZIMINE :- USED FOR MULTIBACILLARY
LEPROSY.

12. 4. CYCLOSERINE :- CAUSES
NEUROPSYCHAATRIC AS
S/E.
. ETHIONAMIDE :- HEPATOTOXIC,
HYPERTHYROIDISM
. PAS :- HYPOTHYROIDISM
5. OTHERS :- . THIOCETAZONE [ NEVER GIVEN IN
HIV PT. ]
. ANTITUBERCULAR WITH UNCERTAIN EFFICACY:-
AMOXYCILLIN + CLAVULANIC ACID
IMPENEM
. NEW DRUG APPROVED FOR MDR/XDRTB :-
BEDAQUILINE , DELAMANID , PRETOMANID.

13. TREATMENT OF TUBERCULOSIS :-
1. DRUG SENSITIVE T.B
CATEGORY 1 :- . IP – 2 HRZE
CP - 4 HRE
CATEGORY 2 :- IP – 2 HRZE
CP – 4 HRE
[HERE IP – NEW TB PT .
AND CP – OLDER TB PT. WHO DISCONTINUE DRUGS OF
TB .]

14. 2. DRUG RESISTANT T.B :-
1. MONO DRUG – RESISTANT TO ANY ONE OF HZE
2. POLY DRUG - RESIST TO MORE THAN ONE OF HZE
3. MDR - RESIST TO H + R
4. RIFAMPCIN RESISTANCE – RESIST TO R , BUT SENSITIVE
TO H
5. EXTENSIVE [XDR] – RESIST TO H+R +ONE OF FQ+ONE OF
INJECTABLE
6. TDR - RESIST TO ALL AVAILABLE DRUGS

15. 3. TREATMENT :-
DRUG SENSITIVITY TESTING DONE BEFORE START DRUG
FOR MDR , RR, XDR .
1. MONO RESIST TB –
IP- 3[FLD +LF+INJ ]
CP- 6[FLD +LF ]
2. POLY RESIST. TB –
IP – 3[FLD+LF+INJ +ETHIO ]
CP – 6 [FLD +LF+INJ+ETHIO ]

16. 3. Mdr –
ip- 6 [ min. 6 drugs ]
cp – 18 [ min. 4 drugs ]
4. rr –
ip – 6 [tx of mdr +h ]
cp – 18 [tx of mdr +h ]
5.xdr –
ip – 6 [ min. 7 drugs ]
cp – 18 [ min. 6 drugs ]….
[key ind:- fld- 1 st line of sensitive drug
lf – levofloxacin
inj – injectable
ethio- ethionamide]…….