Anti TB regiment and complication and precautions

1. Asif Nawas
4th year student,TMC-5

2.  Mycobacterial tuberculosis is a serious health hazard
in all over the world now-a-days. Its caused by some
organism following,
 Mycobacterium tuberculosis
 M. bovis
 M. intercellulari
 Atypical mycobacterium

3.  According to the efficacy
◦ 1st line drugs
 Isoniazid(INH)
 Rifampicin(RMP)
 Ethambutol(EMP)
 Pyrazinamide(PZA)
 Streptomycin(But now-a-days its maximum strains
are
resistant).

4. 2nd line drugs:
-Aminogycosides,
(Amikacin,Kanamycin)
-Polypeptides,
(Capreomycin)
-Fluroquinolones
(Ciprofloxacin,
Levofloxacin, Moxifloxacin)
-Para-aminosalicylic acid
-Cycloserine.

5.  Should be bactericidal.
 should have greatest level of therapeutic
efficacy.
 Acceptable degree to toxicity.
 No rapid development of resistant.

6.  1.Pulmonary tuberculosis
 2.Extra-pulmonary tuberculosis:
 Pleural tuberculosis
 Bone And joint tuberculosis
 Intestinal tuberculosis
 Genitourinary tuberculosis.

7. Category Initial Phase Continuous phase
Pulmonary
tuberculosis and extra
pulmonary
tuberculosis
2 months 4 months
Lymphadenitis
Pleural
Intestinal,
Genitourinary
tuberculosis
2 months 4months
Bones and joints
tuberculosis.
2 months 18 months
(7-10 months) for TB
meningitis

8.  Compound therapy is used in the treatment
of tuberculosis.The main objectives of
compund therapy are-
 1. To avoid better emergence of resistant
develops rapidly.
 To reduce toxicity of drugs.
 Rifampicin+ Isoniazid=Rimactazid

9.  Hypersensitivity:
 INH
 Rifampicin
 Ethambutol.

10.  Hepatotoxicity:
 INH
 Rifampicin
 Pyrazinamide
 Thiacetazone

11.  Optic neuritis:
 Ethambutol
 INH

12.  Arthralgia:
 Pyrazinamide
 Ethambutol.

13.  Ototoxicity: Streptomycin
 GIT upset: Pyrazinamide

14. ◦ patients requiring retreatment should initially receive at
least 5 drugs including rifampicin, Isoniazid,
ethambutol, Pyrazinamide (at least 2 drugs )
◦ Pregnant woman is treated with rifampicin isoniazid and
ethambutol.
◦ In case of MDR(multi-drug resistant TB), pyrazinamide
is the effect for pregnant woman.
◦ Most children are treated with isoniazid and rifampicin
but not ethambutol. Because it causes difficulty in visual
acuity and color perception.
◦ Pregnant woman has high risk of isoniazid –induced
hepatotoxicity. So ALT must be monitored during
treatment.

15. 1.Isoniazid
-100%
2.Rifampicin
-10-20%
3.Ethambutol
-25-50%
4.Pyrazinamide
-100%
5.Cycloserine
-80-100%

16.  The useful corticosteroid is
 Prednisolone, or dexamethasone
 In Case of TB meningitis- Dexamethasone(8-12mg/d)
 In case of TB pericarditis-Prednisolone(60mg/d)

17.  Broad spectrum ANTIBIOTIC
 Bactericidal activity(kills semi dormant
bacilli)
 Kills both extracellular and intracellular
mycobacterium.
 Rifampicin also effective against gram-
positive and gram negative cocci.

18.  Rifampin
 Rifabutin
 Rifapentine.

19.  It inhibits DNA dependent RNA polymerase.
 So it inhibits bacterial RNA synthesis

20. Rifampicin
Binds with the beta-subunit
of bacterial DNA dependent
RNA polymerase
It does not bind with
human cell. So it inhibits
bacterial RNA synthesis.

21.  oral or parenteral route
 Well absorbed in the GIT
 2-4 hours of administration
 Distributed in most body fluid and
tissues.CSF ,pleural cavity, abscess cavities.
 Metabolized in the liver and excreted
through bile feces and urine.

22.  It causes orange red in color of the urine,
tears, sputum that harmless,

23.  Tuberculosis
 Leprosy
 Chemoprophylaxis of meningococcal
Meningitis.
 Streptococcal endocarditis
 Osteomyelitis
 Prophylaxis of children H. Influenza.

24.  Cholestatic Jaundice
 Hepatitis(Drug induced)
 Rash. Fever, Flu-like syndrome
 Nausea ,vomiting, Cramp, epigastric disress.
 diarrhoea.

25.  Chronic liver disease
 Old age
 Alcoholism
 Vasculitis.

26.  Rifampicin+ warfarin= effectiveness
 Rifampicin +OCP= effectiveness of oral pill
 Rifampicin+ steroid= metabolized by liver
enzyme
 Rifampicin+ phenytoin= effectiveness of
phenytoin.

27.  INH is the principle chemotherapeutic agent
for tuberculosis.
 Bactericidal activity
 Able to penetrate into phagocytic cell
 Active against gram positive and gram
negative organism.

28. Isoniazid is activated by mycobacterial catalase
peroxidase
Form a covalent complex with an acyl carrier
protein and beta-ketoacyl carrier protein.
Block the synthesis of mycolic acid leading to
bactericidal action.

29.  Oral route of transmission
 INH is well absorbed in the GIT
 Plasma concentration is at least 1-2 hours
 Distributed in the body cavity specially
CSF(20-100)%
 Hepatic metabolism by acetylation
 Renal excretion.

30. ◦ Treatment of tuberculosis
◦ Prophylaxis of tuberculosis

31.  Those young children whose tuberculin test
negative.
 HLV-infected and AIDS infected patients.
 Those who are in close contact may have
increased risk of contamination,

32.  INH-induced hepatotoxicity.
 Peripheral neuropathy.
 SLE
 Numbness and tingling of the feet.
 optic neuritis, arthralgia.
 Insomnia, restlessness, convulsion.
 Hemolytic anemia in G6PD

33.  Ethambutol is a synthetic ,water soluble,
Heat stable compound.
 Well absorbed from GIT.
 Can cross the blood brain barrier.
 Accumulated in renal failure.

34. Ethambutol
inhibits
mycobacterial
arabinosyl
transferases.
Polymerization
reaction of
arabinoglycan is
inhibited
Defect in
mycobacterial
cell wall
synthesis.

35.  Retro bulbar neuritis
 Retinal damage.

36.  pyrazinamide is the first line drug used with
INH & rifampicin.
 It acts as a sterilizing agents of some
intercellular organism.
 Well absorbed in the GIT
 No cross resistance with other anti –TB drug.

37. Pyrazinamide is up
taken by macrophage
Mycobacterial
pyrazinamidase
activate it
Exert activity against
the organism &
produce “sterilizing”
effect

38.  Hepatotoxicity.
 Nausea
 Vomiting.
 Hyperuricaemia
 Gouty Arthritis.