2.  Chronic granulomatous disease caused
by Mycobacterium tuberculosis.
 Tuberculosis typically attacks the
lungs, but can also affect other parts of
the body.
 It is spread through the air when people
who have an active TB infection
cough, sneeze, or otherwise transmit
respiratory fluids through the air.

4.  Sites of
extra-pulmonary
tuberculosis

6. FirstlineSecondline
 Isoniazid
 Rifampicin
 Pyrazinamide
 Ethambutol
 Streptomycin
 Ethionamide
 Thiacetazone
 Para Aminosalicylic acid (PAS)
 Amikacin
 Capreomycin
 Cycloserine
 Ciprofloxacin
 Kanamycin
 Rifabutin
 Rifapentine

7. tuberculocidaltuberculostatic
 Isoniazid
 Streptomycin
 Capromycin
 Ciprofloxacin
 Rifampicin
 Pyrazinamide
 Kanamycin
 Ethambutol
 Thiacetazone
 PAS
 Ethionamide
 Cycloserine

8.  Most effective and cheapest primary
anti tubercular drug.
 Effective in both acidic and alkaline
medium
 Tuberculocidal for rapidly
multiplying bacilli
 Tuberculostatic for resting
bacilli

9. Mycolic
acids
synthesizes
Isoniazid
inhibits this
synthesis

10.  Peripheral neuritis
 Hepatitis
 Psychosis
 Seizures
 Anorexia
 GIT discomfort
 Fever
 Allergic reactions
Less
common

11.  Semisynthetic derivative of rifamycin
, am anitibiotic obtained from
streptomyces mediterranei.
 Highly effective tuberculocidal
 Acts on both intra
and extracellular
organisms.
 It is called a sterilizing
agent.

12.  Rifampicin binds to beta subunit of DNA
dependant RNA polymerase and inhibits
RNA synthesis in bacteria.
 It cannot bind to human RNA
polymerase, thus selectively destroying
the bacteria.

13.  Hepatotoxicity
 GIT disturbances
 Flu-like syndrome
 CNS symptoms – drowsiness, ataxia,
confusion, peripheral neuropathy etc
 Hypersensitivity reactions
 Staining of secretions

14. TB & atypical
mycobacterial
infections
Leprosy
Prophylaxis in
H. influenza
Resistant staph
infections
Brucellosis
Pneumococcal
meningitis
To eradicate
carrier state

15.  Analog of nicotinamide
 Tuberculocidal
 Requires acidic pH for
its activity
 Mechanism of action
not clearly known.
 HEPATOTOXICITY is the
Most common adverse
effect
May inhibit
synthesis of
mycolic
acids

16.  Tuberculocidal
 Acts only against extracellular organisms
 Has to be given IM
 When used alone
resistance develops.
 Least preferred first
line drug.

17.  Tuberculostatic
 Also effective against
atypical mycobacteria.
 Well absorbed on oral administration
 Dose should be reduced in renal failure
 Optic neuritis is an important adverse effect
which needs withdrawal of the drug.
 It decreases the renal excretion of uric acid
and enhances plasma urate levels.

18.  INH: potent bactericidal
 Rifampicin: potent bactericidal
 Pyrazinamide: weak bactericidal
 Ethambutol: bacteriostatic
 Streptomycin: bactericidal
Synergistic
effect
NEVER USE A SINGLE DRUG FOR CHEMOTHERAPY IN
TUBERCULOSIS, A COMBINATION OF 2 OR MORE IS
ALWAYS BETTER

19.  Less effective
 More toxic
 Used only if organism is resistant to first
line drugs
 Ethionamide , PAS, cycloserine :
bacteriostatic
 Amikacin, capromycin, fluoroquinolones
are used in Multi Drug Resistant TB

20. Phase I
•1-3 months
•Rapidly kills
bacilli
•Symptomatic
relief
Phase II
•4-6 months
•Eliminates
remaining
bacilli
•Prevents
relapse

21. 1. INH+S+T daily for 2 months
2. INH+T daily for 10 months
INH – isoniazid
S – Streptomycin
T - Thiacetazone

22. 1. INH+R+Z+E/S daily or thrice a week for 2
months followed by:
2. INH+R daily or thrice a week for 4
months
3. INH+R+Z trice a week for 2 months
followed by
4. INH+R daily for 7 months.