Treatment of tuberculosis for UG level presentations

1. TREATMENT
OF
TUBERCULOSIS
By-AMIT ANAND
FINAL PROF M.B.B.S
ROLL NO- 11

2. Short Couse Chemotherapy
 It is widely accepted as treatment of choice for TB.
 It includes 6month regimen
 These regimens are divided into 2 phases: an initation
phase or bactericidal phase and a continuation phase or
sterilizing phase.
 During initation phase, majority of mycobacteria are
killed, symptoms resolve and patient become non-
infectious.
 During continuation phase, the semi-dormant “persistors”
are eliminated.

3. DOTS
 Directly Observed Treatment,Short course or DOTS means
administering potent antimicrobial regimens in an
intermittent manner to a patient with tuberculosis under
direct supervision
 DOTS is the backbone of RNTCP
 The basic Objectives of RNTCP are:
• To treat successfully 85% of detected smear-positive
cases.
• To detect 70% of all such cases

4. First line drugs Second line drugs
1) Isoniazid(H) • Ethionamide (Eto) Fluoroquinolones
2) Rifampin(R) • Prothionamide (Pto) • Ofloxacin (Ofx)
3) Pyrazinamide(Z) • Cycloserine (Cs) • Levofloxacin (Lvx/Lfx)
4) Ethambutol(E) • Terizidone (Trd) • Moxifloxacin (Mfx)
5) Streptomycin(S) • Para-aminosalicylic • Ciprofloxacin (Cfx)
acid (PAS) Injectable drugs
• Thiacetazone (Thz) • Kanamycin (Km)
• Rifabutin • Amikacin (Am)
• Capreomycin (Cm)
* Bedaquiline (diarylquinoline) and Delamanid (nitroimidazole) are the 2 newly approved
drugs for use in severe cases of MDR-TB{PGI NOV 2016}
ANTI-TUBERCULAR DRUGS

5. Classification & Treatment Regimen in RNTCP

6. First Line Drugs

7. Drug Main Side-effects
Rifampicin Hepatitis (small ↑AST acceptable, stop if bilirubin↑),
cutaneous hypersensitivity, orange urine & tears (contact lens
staining), inactivation OCP, ‘flu-like syndrome &
thrombocytopenic purpura
Isoniazid Hepatitis, peripheral neuropathy, pyridoxine deficit,
agranulocytosis, psychosis (rare)
Ethambutol Optic neuritis (colour vision is first to deteriorate), nausea,
rashes, fever, rarely peripheral neuritis
Pyrazinamide Hepatitis, arthralgia, hyperuricaemia(gout is a CI), Anorexia,
nausea, flushing, fever & loss of diabtes control
Streptomycin Cutaneous Hypersensitivity, giddiness, numbness,tinnitus,
Vertigi, ataxia, deafness
ADVERSE DRUG REACTIONS

8. Multiple Drug Resistant (MDR) TB
(Category IV)
 Multi-drug-resistant tuberculosis (MDR-TB) is
defined as tuberculosis that is resistant to at
least isoniazid (INH) and rifampicin.
 Multidrug-resistant tuberculosis can be cured with
long treatments of second-line drugs, but these
are more expensive than first-line drugs and have
more adverse effects.

9. Grouping of Anti-TB drugs

10. Intensive phase
(6–9 months)
Continuation phase
(18 months)
1. Ofloxacin (Ofx) or
Levofloxacin (Lfx)
1. Ofloxacin (Ofx) or
Levofloxacin
2. Kanamycin (Km) 2. Ethionamide (Eto)
3. Ethionamide (Eto) 3. Cycloserine (Cs)
4. Pyrazinamide (Z) 4. Ethambutol (E)
5. Ethambutol (E)
6. Cycloserine (Cs)
Standardized RNTCP regimen for
MDR-TB(Category IV)

11. Extremely Drug Resistant TB (XDR-TB)
 XDR-TB is defined as TB that has developed
resistance to at least rifampicin and isoniazid , as
well as to any member of the quinolone family
and at least one of the following second-line anti-
TB injectable drugs: kanamycin, capreomycin,
or amikacin

12. Regimen for XDR TB
 Intensive Phase (6-12 months) 7 drugs-Capreomycin
(Cm), PAS, Moxifloxacin (Mfx), High dose-INH,
Clofazimine, Linezolid, and Amoxyclav
 Continuation Phase (18 months) 6 drugs – PAS,
Moxifloxacin (Mfx), High dose-INH, Clofazimine,
Linezolid, and Amoxyclav