This document provides an overview and update on anti-tuberculosis therapy. It begins by outlining the objectives of becoming familiar with first and second line anti-tuberculosis drugs, their treatment regimens, adverse effects and drug interactions. It then reviews the standard first line treatment regimen of 2HRZE/4HR, describes the common first line drugs isoniazid, rifampin and ethambutol and their adverse effects. It also briefly discusses second line drugs and treatment in special populations before concluding with a review of multi-drug resistant tuberculosis and second line treatment options.
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.
Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.
Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
Definition and introduction to bronchial asthma - classification of bronchial asthma - pathophysiology and risk factors for bronchial asthma - diagnosis of bronchial asthma - clinical manifestations - investigations - management of bronchial asthma
Asthma is a serious public health problem throughout the world, affecting people of all ages. When uncontrolled, asthma can place severe limits on daily life, and is sometimes fatal.
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.
Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications and conditions such as autoimmune diseases. Risk factors include cystic fibrosis, chronic obstructive pulmonary disease (COPD), asthma, diabetes, heart failure, a history of smoking, a poor ability to cough such as following a stroke, and a weak immune system. Diagnosis is often based on the symptoms and physical examination. Chest X-ray, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other methods of prevention include handwashing and not smoking. Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.
Pneumonia affects approximately 450 million people globally (7% of the population) and results in about four million deaths per year. Pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death". With the introduction of antibiotics and vaccines in the 20th century, survival improved. Nevertheless, in developing countries, and among the very old, the very young, and the chronically ill, pneumonia remains a leading cause of death. Pneumonia often shortens suffering among those already close to death and has thus been called "the old man's friend"
Definition and introduction to bronchial asthma - classification of bronchial asthma - pathophysiology and risk factors for bronchial asthma - diagnosis of bronchial asthma - clinical manifestations - investigations - management of bronchial asthma
Asthma is a serious public health problem throughout the world, affecting people of all ages. When uncontrolled, asthma can place severe limits on daily life, and is sometimes fatal.
Dexamethasone Sodium Phosphate Injections (Dexona Injections) is used to treat many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, Cerebral oedema(raised intracranial pressure),auto-immune, endocrine, pulmonary, blood disorders or breathing disorders.
Hello members...this is my 39th powerpoint...
It deals with LABA & SABA...The brochodilators used in the treatment of Pulmonary diseases like Asthma & COPD.
It gives a short insight into the drugs used, their indications with dosages, ADRs, interactions, etc.
Worthwhile for a precise information on the same!!
Happy reading!!!
:) :)
Most about status asthmaticus, you will find from etiology to treatment and ventilator management. This presentation is made with thanks to medscape and other resources.
In this presentation, mainly I concentrated on Metronidazole, which is an anti-biotic; and talking about it's pharmacokinetics, drug indication, contraindication, adverse drug reactions and taking the drug during pregnancy and lactation, finally I hope you enjoy it as much as I DID, SALAAM.
Gastro esophageal Reflux Disease (GERD) and its managementDr. Ankit Gaur
In this presentation I have tried to explain in brief about gastro esophageal Reflux Disease (GERD), its etiology, risk factors, diagnosis, and its management via pharmacotherapy.
Dexamethasone Sodium Phosphate Injections (Dexona Injections) is used to treat many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, Cerebral oedema(raised intracranial pressure),auto-immune, endocrine, pulmonary, blood disorders or breathing disorders.
Hello members...this is my 39th powerpoint...
It deals with LABA & SABA...The brochodilators used in the treatment of Pulmonary diseases like Asthma & COPD.
It gives a short insight into the drugs used, their indications with dosages, ADRs, interactions, etc.
Worthwhile for a precise information on the same!!
Happy reading!!!
:) :)
Most about status asthmaticus, you will find from etiology to treatment and ventilator management. This presentation is made with thanks to medscape and other resources.
In this presentation, mainly I concentrated on Metronidazole, which is an anti-biotic; and talking about it's pharmacokinetics, drug indication, contraindication, adverse drug reactions and taking the drug during pregnancy and lactation, finally I hope you enjoy it as much as I DID, SALAAM.
Gastro esophageal Reflux Disease (GERD) and its managementDr. Ankit Gaur
In this presentation I have tried to explain in brief about gastro esophageal Reflux Disease (GERD), its etiology, risk factors, diagnosis, and its management via pharmacotherapy.
Brief information about Tuberculosis, drugs used for its treatment including recent advances and drug regimen for patients of different categories of TB suggested by WHO (DOTS therapy) including national and international programes for preventing TB.
Anti Tubercular Drugs - Mechanism of Action and Adverse effects Thomas Kurian
A brief outline of the mechanism of action and adverse effects of anti tubercular drugs
Only First line and second line drugs are dealt with.First line drugs may be useful for MBBS students and the rest is directed for postgraduate students.
Hope you find it useful.
Tuberculosis is completely curable disease now a days but one should follow the treatment regimens correctly .so for under graduate MBBS students it is clearly explained with animations.Hope you all this will be helpful.
This PPT covers drug therapy for tuberculosis. It includes classification of antitubercular drugs, chemotherapy for tuberculosis, strategies for addressing resistance and pharmacotherapy of antitubercular drugs
Introduction
Mycobacteria are intrinsically resistant to most antibiotics & they grow slowly compared with other bacteria.
Thus antibiotics that are most active against growing cells are relatively ineffective.
Mycobacterial cells can also be dormant & thus completely resistant to many drugs or killed only very slowly.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Objectives
Become familiar with the first and second line anti-
tuberculosis antibiotics and the standard treatment
regimes.
Identify the common adverse effects and drug
interactions associated with these antibiotics.
Describe problem-solving techniques that are
used to help identify and manage common
adverse effects.
3. Outline
Review the first line agents
Discuss duration of therapy
Review common side effects and
management
Review treatment of TB in special populations
Short talk about drug resistance and second
line agents
4. The scope of the problem
A 2 cm cavity contains 108 organisms.
There are naturally occurring mutations to all our TB
drugs.
Use of monotherapy allows the selective growth of
the resistant organisms and gives rise to drug
resistance.
A prolonged course of antibiotics is required to kill the
semi-dormant and dormant organisms.
5. In order to treat TB you must
Take into consideration:
Known or suspected drug resistance
• Hx of prior TB treatment
Location of disease
• Standard tx is 6 months
• TB meningitis: 9-12 months
Likelihood of adherence and/or adverse
reactions
Co morbidities and host immune status
6. Category I
•New (untreated)smear positive pulmonary TB
•New smear negative pulmonary TB
•New cases of severe forms of extrapulmonary TB
( meningitis,spinal,intestinal,genitourinary TB).
Category II
These are smear positive failure, relapse and
Interrupted treatment cases
Patient catogories
7. Category III
These are new cases of smear negative pulmonary TB
With less severe form of extrapulmonary TB, (skin
Bone,peripheral joint TB).
Category IV
These are chronic cases who have become smear
Positive after completing fully supervised retreatment.
These are mostly MDR cases.(multi drug resistant)
8. TB Category Initial phase Continuation
phase
Total duration
I 2 HRZE (S) 4 HR/ 4 H3R3
Or 6 HE
6
8
II 2 HRZES + 1 HRZE 5 HRE or 5H3R3E3 8
8
III 2 HRZ 4 HR/ 4 H3R3 0r 6
HE
6
8
IV Chronic case
9. Standard treatment regime
Intensive phase
Goal is to quickly kill the rapidly dividing
organism to control disease
render patient non-infectious
prevent emergence of drug resistance
Continuation phase
Sterilize the lungs by killing dormant and
semi-dormant organisms to prevent
relapse
10. Give all meds together as a
single dose unless:
Profound nausea, vomiting
Swallowing issues
11. Antituberculosis drugs (by group)
Group Description Drug Abbreviation
1. First-line oral antituberculosis drugs isoniazid
rifampicin
ethambutol
pyrazinamide
rifabutin
H
R
E
Z
Rfb
2. Injectable antituberculosis drugs kanamycin
amikacin
capreomycin
streptomycin
Km
Amk
Cm
S
3. Fluoroquinolones levofloxacin
moxifloxacin
ofloxacin
Lfx
Mfx
Ofx
4. Oral bacteriostatic second-line
antituberculosis drugs
ethionamide
protionamide
cycloserine
terizidone
p-aminosalicylic acid
Eto
Pto
Cs
Trd
PAS
5. Antituberculosis drugs with unclear efficacy
or unclear role in MDR-TB treatment (not
recommended by WHO for routine use in MDR-
TB patients)
clofazimine
linezolid
amoxicillin/clavulanate
thioacetazone
clarithromycin
imipenem
Cfz
Lzd
Amx/Clv
Thz
Clr
Ipm
13. 2HREZ/4HR
In intensive phase
H,R: kill rapidly dividing TB
Z: works to kill semi dormant TB in the acidic
environment of the cavity or in macrophages
E: used to prevent the emergence of RIF
resistance when primary resistance to INH may be
present
In continuation phase
H,R: kill any remaining rapidly dividing cells as
well as sterilizing fibrotic areas
14. 14
Rifampin
Binds to DNA-dependent RNA polymerase
The most important drug we use
Bactericidal against rapidly dividing agents, and
penetrates into fibrotic areas to kill semidormant
organisms
Without rifampin treatment course is 12-18 months
Usual dose 10 mg/kg max 600mg
15. Rifampin side effects
Change in colour of urine, sweat
Pruritis with or without rash: 6%
Hepatotoxicity
Significant transaminase elevation: rare
Can be seen as part of hypersensitivity rx
Dose dependent interference with bilirubin
uptake causing unconjugated hyperbilirubinemia
or jaundice without LFT abnormalities
Thrombocytopenia
Hypersensitivity rx in 0.07-0.3%
18. 18
Isoniazid side effects
Peripheral neuropathy
Dose related side effect
Vit B6 supplements to prevent
Rare: seizures
+ANA antibodies in 20%, less than 1%
develop lupus
*
19. INH Hepatotoxicity
Hepatitis
Incidence increases with age
Generally occurs within weeks to months rather
than days
Takes weeks to regress, recovery is complete in
most following drug cessation
20. 20
INH Drug Interactions
INH inhibits cytochrome P450 system
Increase concentrations of:
carbamazepine, phenytoin, cycloserine,
theophylline, warfarin
These effects are offset with rifampin
Check levels
21. 21
Pyrazinamide
Active against dormant and semi-
dormant TB within macrophages or in
acidic environments
No PZA → minimum of 9 months of tx
Dose is 25 mg/kg, requires renal dosing
22. 22
Pyrazinamide side effects
Hepatotoxicity
Actual incidence hard to predict as PZA always
used with other TB meds, in one study
hepatotoxicity attributed to PZA in 1%
Rash
Non gouty arthralgia
Seen in up to 40% of patients on daily Z
23. 23
Ethambutol
Inhibits arabinosyl transferase (synthesis of
TB cell wall component), (This may
increase penetration of other drugs into
the organisms).
Suppresses growth (static)
Less bactericidal compared to INH or RIF
Dose: 15 mg/kg
Requires renal dosing
24. 24
Ethambutol side effects
retrobulbar neuritis
• Manifests as decreased visual acuity or decreased
red-green colour discrimination in one or both eyes
• Risk higher in pts with renal failure
Rarely used in children due to an inability to
monitor for symptoms
25. 1) In case of resistance to first line agents;
2) In case of failure of clinical response to conventional
therapy.
3) In case of serious treatment limiting adverse drug
reactions.
4) When expert guidance is available to deal with the
toxic effects, because the dosage, emergence of
resistance & long-term toxicity have not been fully
established.
Second Line / Alternate Anti T.B Drugs:
27. Streptomycin
Aminoglycoside antibiotic.
First line Anti TB drug, given by injection.
Given I/M or I/V as Streptomycin sulfate.
Crosses BBB & achieves therapeutic conc. if meninges
are inflamed.
28. Clinical Uses
Mycobacterium TB Infections:
Used when an injectable drug is required in severe ,life
threatening form of infection:
• Disseminated Tuberculosis
• Tuberculous Meningitis
• Infections resistant to other drugs.
Dose: 1 g / (15mg/kg/day) I/M or I/V daily.
20-40mg/kg/day for children-not to exceed
1-1.5 G/d.
Given in combination with other drugs to delay /
prevent emergence of resistance.
29. Adverse Effects
Main toxic effects are:
Ototoxicity—vertigo & hearing loss ,may be permanent.
Nephrotoxicity—dose related ,more in elderly.
Dosage adjustment according to Creatinine CL.
Toxicity can be reduced by limiting the therapy for 6
months.
30. Antibiotic derived from Rifamycin & is related to Rifampin.
Less potent inducer of cytochrome P450 less D/I.
Active against Myco. TB & Atypical mycobacteria.
Rifabutin
31. Uses: For treatment of mycobacterial TB infection in
place of Rifampin in HIV-infected patients receiving Anti-
viral treatment.
In AIDS patients.
Prevention of T.B: alone for 6 months or with
pyrazinamide for 2 months
Prevention and treatment of disseminated atypical
mycobacterial infection.
Dose: 300mg/day orally.--- 150mg/day with protease
inhibitor.
450mg/day with Efavirenz ( also an inducer of p450
enzymes)
32. Analog of Rifampin.
Cross resistance with Rifampin
Potent inducer of cytochrome P450 like Rifampin
, so similar drug interactions.
Active against Myco .TB & Atypical mycobacteria.
Rifapentine
33. Therapeutic uses:
For ttt of Rifampin susceptible strains during
continuation phase. 600mg / week orally.
C/I: HIV infected patients --- high relapse rate with
Rifampin resistant Mycobacteria.
34. Activates macrophages to kill Myco. T.B
Given by Aerosol to the lungs of patients with
multidrug resistant TB.
There is wide pulmonary distribution &
enhanced local immune stimulation.
Interferon-γ
35. Kanamycin (Km)
Aminoglycoside
Interferes with protein
synthesis through disruption of
ribosome
Dose: 1 g IM/IV (15-20 mg/kg)
Side effects:
Nephrotoxicity
Ototoxicity
Electrolyte wasting
Adjust dose for renal failure
36. Amikacin (Amk)
Aminoglycoside
Highly similar to kanamycin (can
be essentially considered the
same drug)
Dose: 1 g IM/IV (15-20 mg/kg)
daily
Side effects:
Same as kanamycin; renal
failure and ototoxicity
High cross-resistance with
kanamycin
Adjust dose in renal failure
(same as kanamycin)
37. Capreomycin (Cm)
Structurally and
functionally similar to
aminoglycosides
Dose: 1 g IM/IV (15-20
mg/kg) daily
Side effects
same as Km/Amk
Some cross-resistance
with Km/Amk
Adjust dose for renal failure
38. Ofloxacin (Ofx)
Inhibits DNA-gyrase
Dose: 800 mg daily
Side effects
Generally well-tolerated
GI upset, rash, CNS
disturbance
Avoid antacids around time of
ingestion (reduces
absorption)
Near complete cross-resistance
with other fluoroquinolones
39. Levofloxacin (Lfx)
Dose: 750 mg daily for
<50 kg (1000 mg daily
for > 75kg)
A higher dose for
tuberculosis is used than
for other infections
Side effects
Generally well-tolerated
GI upset, rash, CNS
disturbance
Adjust dose in renal failure
40. Moxifloxacin (Mfx)
May be more active than earlier
generation quinolones
Dose: 400 mg daily
Near complete cross-resistance
with other fluoroquinolones
No dose adjustment in renal
failure
Hepatically cleared
41. Ethionamide (Eto)
Derivative of isonicotinic acid
(same family as isoniazid)
Dose: 500-1000 mg daily in
divided doses
Side effects
GI upset, hypothyroidism,
peripheral neuropathy
Partial cross-resistance with
isoniazid, complete with
prothionamide
Hepatically excreted
Co-administer vitamin B6
42. Prothionamide (Pto)
Structurally similar to
ethionamide
Dose: 500-1000 mg daily
in divided doses
Overall side effect profile
similar to ethionamide
Slightly less GI side
effects
Complete cross-resistance
with ethionamide
44. Terizidone (Trd)
Structure is composed of two connected molecules
of cycloserine
Commonly used in South Africa in place of
cycloserine
Dose: 500-1000 mg daily in divided doses
Possibly less side effects than cycloserine
Not yet recommended by the WHO
45. Para-aminosalicylic acid (PAS)
Various formulations; delayed-
release microcapsules best
tolerated
Dose of PASER is 4 g (1 sachet)
twice daily
Side effects
GI upset, hypothyroidism
Hepatitis, electrolyte abnormalities
Hepatic metabolism, renal
excretion
Administer with acidic food or
drink
46. Group 5: Possible reinforcing agents
Minimal clinical data to support use in MDR-TB
therapy.
Should only be used in cases of extreme drug
resistance (XDR-TB):
Amoxicillin/clavulanic acid
Clofazamine
Linezolid
High dose isoniazid
Imipenem
47. Amoxicillin-clavulanic acid (AMX-CLV)
GROUP 5
Beta-lactam antibiotic with
beta-lactamase inhibitor
Dose
1000/250 mg twice daily or
875/125mg twice daily
Side effects
GI upset, rash
Contraindicated: Penicillin
allergy
48. Clofazimine (CFZ)
GROUP 5
Substituted
iminophenazine
Usual adult dose is 100
mg daily
Side effects
Bronzing of skin
Malabsorption
Abdominal pain (can
be severe)
49. Linezolid (LZD)
GROUP 5
Oxazolidinone: inhibits protein synthesis,
interacting with ribosomal RNA
Dosing
Coated tablets: 400 and 600 mg
Intravenous solution: 2 mg/ml; 100, 200, or
300 mg bags
Usual dose: 600 mg twice daily.
Some case series have successfully used daily
half dosing (600 mg once daily) to decrease
toxicity and maintain efficacy
50. Linezolid (LZD) (Continued)
Side effects
Generally well tolerated for treatment courses ≤28
days.
Common: diarrhea, nausea, headache, insomnia, and
rash.
More serious:
• myelosuppression (generally reversible with discontinuation of
the drug)
• optic neuropathy (usually resolved over time with drug
discontinuation)
• peripheral neuropathy (possibly irreversible).
Rare: hypertension, lactic acidosis, pancreatitis
51. Linezolid (LZD) (Continued)
Monitoring
CBC weekly during the initial period, then monthly, and then as
needed based on symptoms.
Visual function should be monitored in all patients taking linezolid
for extended periods (≥3 months) and in all patients reporting new
visual symptoms regardless of length of therapy.
Alerting symptoms:
Black, tarry stools or severe diarrhea
Unusual bleeding or bruising
Extreme tiredness or weakness
Numbness, tingling, or burning pain in your hands, arms, legs, or
feet
Change in visual acuity, vision blurring, or visual field defect
Headache, nausea, or vomiting
52. High-dose isoniazid (H)
GROUP 5 (AT HIGH
DOSES)
Dosing
16 to 18 mg/kg per day,
typically 600 mg to 1200
mg per week
Some clinicians give it
three times a week
instead of daily at the 16
to 18 mg/kg dosing
53. Imipenem/Cilastin
GROUP 5—BETA-LACTAM/CARBAPENEM
In vitro activity—very limited clinical experience
Dosing
Adults: 1000 mg IV every 12 hours
In children, meropenem preferred: 20-40 mg/kg/dose
IV every 8 hours up to 2 grams per day (high rates of
seizures were seen in children treated with imipenem
for TB meningitis
Side effects
Diarrhea, nausea, vomiting
Seizure noted in CNS infections
54. Management of patients with adverse drug
reactions to Anti-tubercular drugs:
Minor A/E ---- managed symptomatically without altering
medication.
Severe A/E ---- stop the offending drug if possible isoniazid ,
rifampin should be continued or re-introduced after the
reaction has subsided.
Never re-introduce in case haemolysis, thrombocytopenia or
renal failure.
55. Monitoring for side effects during
therapy
Clinical
Screen for common side effects
Microbiological response
Sputum at 2 months
Sputum at completion of therapy
Laboratory response
First 2 weeks: twice weekly
At 1 month then monthly
Check: AST, ALT, Bilirubin, CBC
56. Common problems during therapy
Nausea and vomiting
Abnormal LFTs
Drowsiness
Rash/puritis
Missed doses
57. SYMPTOM MANAGEMENT
Drowsiness:
HS dosing
Nausea:
Have light food 30 – 60 minutes prior to DOT
Antiemetic 30 minutes prior to DOT
Stronger antiemetic/ranitidine/PPI
Rash/Itch:
Minor itch continue meds with antihistamine (usually
RMP)
Major rash drug challenge after rest
– RMP/INH/EMB/PZA (usually PZA)
58. Hepatotoxicity
Asymptomatic increases in LFTs occur in
20% of pts on tx for TB
Most common serious side effect
Defined as AST >5xULN or >3xULN with
symptoms
Incidence depends on
Age
Pre-existing liver disease
ETOH: appears to more than double risk of INH
hepatotoxiticity
INH more hepatotoxic than rifampin
59. What to do if a patient develops
abnormal LFTs on therapy?
AST/ALT 5X ULN asymptomatic or
AST/ALT 3X ULN symptomatic or
Jaundice
→ HOLD TB Meds
Once ALT returns to <2x ULN then
• Restart rifampin alone or with ethambutol, repeat ALT on
day 3
• IF ALT <2x ULN then add in INH and repeat ALT in 3
days
• Rechallenge with PZA may be hazardous and consider
D/C and extending tx to 9 months
61. Re-introduction of TB drugs (1)
LFTs normal or AST/ALT <2x upper limit
If LFTs due to EtOH (or not due to TB drugs)
restart RHZ together
If bilirubin and ALP
rifampicin most likely
start HE
add Z 1 week later if OK
If OK, use S (+Fq)
62. Re-introduction of TB drugs (2)
ATS : R RH RHE (2RHE/7RH)
Common: H RH RHE (2RHE/7RH)
NYBTC: E ER REZ (2REZ/7RE)
• If R the problem, 2SHEZ/10HE
• If H the problem, 2REZ/7RE
• If Z the problem, 2SHE(Fq)/10HE
63. Rash
If minor, consisting of mainly puritis or
affecting limited area
→ trial antihistamines
Petechial rash
Check platelet count
Generalized rash especially with fever or
involving mucocutaneous areas
→ hold all TB meds
Once rash subsides: restart drugs one by one
Rif → INH→ethambutol or PZA. If no rash with 3rd
drug then assume it is the 4th drug that is the
cause
65. Paradoxical Reactions
Worsening of TB adenitis with
development of new lymph nodes,
increasing lymph node size or sinus
drainage
Seen in up to 20% of patients
Median time to onset: 1.5 months
Can present with new pleural effusions
during trt for Pulm TB
66. Mgmt of Paradoxical Reactions
Rule out drug resistant TB
Aspiration of lymph nodes, effusions
Corticosteroids
Unproven benefit
NSAIDS
67. Treatment of patients in special
populations
Hepatic Disease
Epilepsy
Renal insufficiency/ESRD
HIV infection
Pregnancy/breastfeeding
68. Treatment in patients with pre-existing
liver disease
Remember ↑ AST/ALT may be secondary to
TB
If ALT more than 3xULN not related to TB
Avoid PZA
IF patient has cirrhosis
Rifampin + ethambutol + fluoroquinolone
69. Severe liver disease with encephalopathy
Ethambutol, fluoroquinolone, aminoglycoside (or
capreomycin), cycloserine
recommended regimens are;
2SHRE/6HR OR 2SHE/10HE
70. INH may be associated with an increased
risk of seizures.
Pyridoxine 10 mg daily should be given to
all epileptics taking INH.
There is no evidence that INH causes
seizures in patients who are not epileptic.
Epilepsy
71. TB treatment involves numerous drug
interactions with anti-epileptic drugs
and serum drug levels should be
closely monitored.
There are serious interactions between
rifampicin and carbamazepine,
rifampicin and phenytoin, and
rifampicin and sodium valproate.
72. Renal insufficiency/ESRD:
Dose adjust Z and E if CrCl<30ml/min or on
PD or HD
Intensive:
INH/RMP OD post HD
PZA/EMB 3X per week post HD
Continuation
INH/RMP 3X per week post HD
No data on peritoneal dialysis
2HRZ/4HR
73. Antituberculosis drugs in
hemodialysis patients
Confusion exists regarding regimen,
duration etc however,
Treatment duration should follow NICE
guidelines (UK) namely,
6 months for most cases of fully sensitive
disease, with the exception of
TB involving the CNS when treatment
should be for 1 year
75. For patients on haemodialysis, dosing
intervals should be increased to three times
weekly to reduce the risk of drug
accumulation and toxicity
pryazinamide Variable doses of 25-30 mg/kg
three times weekly or 40 mg/kg three times
weekly have been recommended
76. Treatment can be given immediately after
haemodialysis to avoid premature drug removal
With this strategy there is a possible risk of raised drug
levels of ethambutol and pyrazinamide between dialysis
sessions. Alternatively, Treatment can be given 4-6 h before
dialysis, increasing the possibility of premature drug removal
but reducing possible ethambutol or pyrazinamide toxicity
Both rifampicin and isoniazid may be given in their usual
daily doses.
77. HIV infection:
CD4 count <200
OD 7/7 X 2 months for intensive phase
3X per week for continuation phase
Protease inhibitor interaction with Rifampin
Rifabutin in consultation with HIV pharmacist
Starting of ART (on new HIV DX)
Dependent on CD4 count
78. 78
TB and HIV Drug Interactions
Rifampin and Protease inhibitors (PI)
Effect: Decreased PI serum levels
Substitute Rifampin with Rifabutin 150 mg po thrice
weekly (may need to increase to 300 mg thrice
weekly or 150 mg po daily)
Rifampin and Efavirenz
Effect: Decreased efavirenz levels
Increase efavirenz dose to 800 mg po daily (usual
600 mg daily)
Rifampin and Raltegravir
Effect: Decreased raltegravir levels
Increase raltegravir to 800 mg po BID (usual dose
400 mg po BID and continue higher dose for at least
2 weeks post completion of Rifampin)
79. Initial phase for 2 months
Continuation phase for 7- 10months (total 9-12 M)
In resistant cases up to 18 months
T.B in AIDs patients
80. Pregnancy
TB not an indication for pregnancy
termination
First line drugs safe in pregnancy (H,E,R)
PZA: limited data with respect to teratogenic
effects. Recommended by WHO and IUATLD
Fluoroquinolones and aminoglycosides
contraindicated while pregnant
81. Breastfeeding Moms
1st line drugs
Very small concentrations in breast milk
Encourage breast feeding
Have not shown to produce toxic effects in newborn
Mum should be on pyridoxine supplements
Drugs level in breast milk not sufficiently high to be
considered effective tx for infant
Certain 2nd line drugs not recommended - data
unknown
82. Concerns re poor absorption
Consider if significant malnutrition, diabetic
gastroparesis, HIV, underlying GI disease, treatment
failure
INH/RMP serum levels:
Usually 2 hours (+/- 6 hours) post oral drug adminstration
Available IV drugs include INH, RIF,
fluoroquinolones, aminoglycocides
Recommendations-Parental route (delays discharge)
Only select drugs via Home Care/Mount Carmel Clinic/Lions
Place in WRHA
83. Drug resistance
Primary versus acquired
PZA resistance: treat for 9 months
INH monoresistance
6 month R,Z,E
12 months of 2RZE/10RE
MDR= resistance to INH and RIF
86. Management of MDR-TB
Injectable: used daily for first 2-6 months then
can be stepped down to 3x/week, ideally for
>6 months
Must have daily directly observed therapy for
the duration of therapy
Duration: 18-24 months after sputum
conversion
87. Treatment Monitoring
Sputum smear microscopy for AFB at 2 months
and 6 months
If positive at two months, repeat at 3
If still smear positive at 3 months, continuation
phase (4HR) is still started while awaiting DST
results
Continue drug-susceptibility tests if smear-
positive after 3 months of treatment
88. Monitoring during treatment of DR-TB
Monitoring evaluation Recommended frequency
Evaluation by clinician At baseline, and at least monthly until conversion, then
every 2–3 months
Screening by DOT worker At every DOT encounter
Sputum smears and
cultures
Monitor smears and cultures monthly throughout treatment. (Note:
programmes with limited resources may choose to do smears monthly
but cultures only every other month)
Weight At baseline and then monthly
Drug susceptibility At baseline in programmes doing individualized treatment
Chest radiograph At baseline, and then every 6 months
Serum creatinine At baseline, then monthly if possible while receiving an
injectable drug. Every 1–3 weeks in HIV-infected patients,
diabetics and other high-risk patients
Serum potassium Monthly while receiving an injectable agent. Every 1–3
weeks in HIV-infected patients, diabetics and other high-risk
patients
89. Monitoring evaluation Recommended frequency
Thyroid stimulating hormone
(TSH)
Every 6 months if receiving ethionamide/protionamide
hormone and/or PAS; and monitor monthly for
signs/symptoms of hypothyroidism. TSH is sufficient for screening for
hypothyroidism; it is not necessary to measure hormone thyroid levels
Liver serum enzymes Periodic monitoring (every 1–3 months) in patients
receiving pyrazinamide for extended periods or for patients
at risk for or with symptoms of hepatitis. For HIV-infected
patients, do monthly monitoring
HIV screening At baseline, and repeat if clinically indicated
Pregnancy tests At baseline for women of childbearing age, and repeat if
indicated
Haemoglobin and
white blood count
If on linezolid, monitor weekly at first, then monthly or as
needed based on symptoms; there is little clinical experience
with prolonged use
For HIV-positive patients on an ART regimen that includes AZT,
monitor monthly initially and then as needed based on symptoms
Lipase Indicated for work up of abdominal pain to rule out
pancreatitis in patients on linezolid, D4T, ddI, ddc.
Lactic acidosis Indicated for work up of lactic acidosis in patients on linezolid or ART
Serum glucose If receiving gatifloxacin, monitor glucose frequently (weekly) and educate patient on
signs and symptoms of hypoglycaemia and hyperglcycaemia
90. Mode of action & Recommended dose mg/kg
Twice/wk3times/wkDaily dose
mg/kg
Mode of
action
Essential anti-
tuberculosis drug
15105bactericidalINH
101010bactericidalRifampicin
503525bactericidalpyrazinamide
151515bactericidalstreptomyicin
453015bacteriostaticEthambutol
92. Cross-resistance
Aminoglycosides
Minimal cross resistance between SM and
other aminoglycosides
KM and AM have almost complete cross
resistance
Cross resistance between CM and KM
and/or AM has been documented
Fluoroquinolones
Mutations that confer resistance to one
fluoroquinolone will confer some degree of
93. It is the practice of treating latent infection to prevent
progression to active disease
Indications:
1. In close contacts of active pulmonary TB patients
2. Immunosuppressed / HIV infection & AIDS pts , Diabetes
Mellitus
3. Recent converters.
4. Neonate of tubercular mother.
Chemoprophylaxis/Prevention of TB
94. Isoniazid: DOC
300 mg (10mg/kg in children daily for 6-12 months) with
pyridoxine.
Rifampin: (10 mg/kg) alone for 4 months.
Pyrazinamide: With rifampin for 2 months.
For multidrug resistant mycobacteria with fluroquinolones /
Rifabutin
In pregnancy prophylaxis should be delayed untill delivery.
Drugs Used for chemoprophylaxis:
95. Initial intensive phase is longer (3 months)
5 drugs for 2 months & 4 drugs for 1 months
Continuation phase is longer i.e. 5 months
Use alternate drugs if mycobacteria are resistant to first line
drugs.
Treatment of Previously
treated / failure / default / relapse cases:
96. a) In seriously ill patients (miliary or severe pulmonary TB) to
buy time for drugs to act.
b) When hypersensitivity reactions occur to antitubercular
drugs.
c) In meningeal or renal TB or pleural effusion – to reduce
exudation and prevent its organisation, strictures etc.
d) In AIDS patients with severe manifestations of T.B
Role of corticosteroids in tubercular patients:
97. Contraindication: Intestinal T.B --- silent perforation can
occur.
Precaution: Corticosteroids, if given, should be
gradually withdrawn when the general condition of the
patient improves.
98. Take home points
Duration of tx depends on results of 2 month
cultures and the inclusion of PZA
Treatment completion depends on the
number of doses taken not duration of tx
Many side effects do not require
discontinuation of tx
99. Take home points-cont
Beware of drug-drug interactions
Hepatotoxicity is the most common serious
side effect requiring discontinuation of drug
Introduce Rif then INH once LFTs return to normal