This presentation summarizes tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis. It defines TB and discusses its pathogenesis, risk factors, diagnosis and treatment. Diagnostic tests include tuberculin skin testing, sputum smear microscopy, chest radiography and nucleic acid amplification. Treatment involves a combination of first-line antibiotics like isoniazid, rifampin and pyrazinamide over 6-9 months. Management also includes measures like proper nutrition and avoiding tobacco and alcohol to aid treatment. Drug-resistant TB like multi-drug resistant TB poses challenges and requires utilizing second-line drugs. The desired outcomes of TB treatment are rapid identification, appropriate treatment, resolution of symptoms and adherence to cure the infection

1. CLINICAL
PHARMACY
PRESENTATION
BY SAMREEN FATIMA
MUHAMMAD MUBASSHIR
Presented to
Dr Faksheena

2. TUBERCULOSIS

3. OUTLINE
DEFINITION
MYCOBACTERIUM TUBERCULOSIS
AETIOLOGY
PATHOPHYSIOLOGY
DIAGNOSIS
TREATMENT AND MANAGEMENT
i) Pharmacological
ii) Non Pharmacological
DESIRED OUTCOMES

4. What is
T
uberculosis
(TB) ?
Causative agent
“MYCOBACTERIUM
TUBERCULOSIS”
Communicable
infectious disease
Produce silent ,
latent infections
Progressive ,
active disease

5. Aetiology

6. Aetiology
MYCOBACTERIUM TUBERCULOSIS

 Mycobacteria – Rod shaped-
Aerobic Bacilli
Characteristics of both gram
+ve and –ve
 Cell wall – Mycolicacid
Mycolic acid
 Virulent
 Long chain Beta hydroxylated
fatty acids
 Highly Lipophilic
 Ziehl-Neelsen Stain(Acid
fast staining method)

7. Aetiology
Latent TB
infection
Active TB
infection
Milliary TB
infection
(MTBI)

8. RISK FACTORS OF TUBERCULOSIS
 Co infection with Human immunodeficiency Virus (HIV)
 Crowded living conditions
 Immunosuppressants
 Migration from a country with a high number of TB cases
 Alcoholism
 Cancer of the head and neck
 Smoking - Smokers who develop TB should be encouraged to
stop smoking to decrease the risk of relapse

9. EPIDEMIOLOGY

10. EPIDEMIOLOGY
 Roughly one of every three people is infected by M.
Tuberculosis
 High incidence of TB in Southern Asia and Sub – Saharan Africa
 59% of TB patients in United State are foreign born , most
often from Mexico , Philippines , Vietnam , India
 With The Spread of AIDS , TB continues to lay waste to large
populations
 The emergency of drug resistant organism threatens to make
this disease once again incurable

11. PATHOPHYSIOLOGY

12. PATHOPHYSIOLOGY
EXPOSURE TO
SOURCE
AEROSOLIZA
TION
OF DROPLETS
MUCOCILIARY
BEATING
NO
INFECTION
(>50%)
CD4 LYMPHOCYTE
GRANULOMATOUS LESIONS
BEGINS TO FORM (NECROSIS)
BACTERIA MULTIPLY IN
MACROPHAGES
LESION LIQUIFIES
SPREAD TO BLOOD ORGANS
DEA
TH
BACTERIA CEASE TOGROW
IMMUNE
SUPPRESSION
REACTIVATION
BACTERIA
COUGHED UP IN
SPUTUM
LUNGS

13. DIAGNOSIS

14. DIAGNOSIS
TUBERCULIN
SKIN TEST
SPUTUM TEST CHEST
RADIOGRAPHY
NUCLEIC ACID
AMPLIFICATION

15. DIAGNOSIS > TUBERCULIN SKIN TEST

16. DIAGNOSIS > SPUTUM TEST
 Smear is prepared
 Zeihl Nielsen Acid Fast Stain Method

17. DIAGNOSIS >CHEST
RADIOGRAPHY
The radiograph shows an
abnormal shadow of lungs with
active tuberculosis.

18. DIAGNOSIS >NUCLEIC ACID AMPLIFICATION
A new test can reveal in less than two hours , with very high accuracy

19. DIAGNOSIS > NUCLEIC ACIDAMPLIFICATION
Species identification
: several hours
Low sensitivity High cost

20. TREATMENT AND
MANAGEMENT

21. TREATMENT AND MANAGEMENT
PHARMACOLOGICAL NON
PHARMACOLOGICAL

22. PHARMACOLOGICAL

23. TREATMENT AND MANAGEMENT
FIRST LINE
ANTI TB
RIFAMYCINS
ISONIAZID
PYRAZINAMIDE
ETHAMBUTOL
SECOND LINE
ANTI TB
QUINOLONES
STREPTOMYCIN
KANAMYCIN
MACROLIDES
CYCLOSERINE
ETHIONAMIDE

24. RIPE

25. RIPE

26. TREATMENT – ACTIVE TB
ISONIAZID
6MONTHS
ADULT
300MG/DAY
CHILD 10MG/KG
RIFAMPICIN
6 MONTHS
ADULT600MG/DAY
CHILD 600MG
PYRAZINAMIDE
2 MONTHS
ADULT 2G/DAY
CHILD 300MG
INITIAL PHASE
2 MONTHS
CONTINUOUS PHASE
4 MONTHS

27. TREATMENT – LATENT TB
ISONIAZID
9 MONTHS >30KG PO qDAY
TREATMENT IN HIVNEGATIVE
ISONIAZID +
RIF
APENTENE
3 MONTHS PO 900MG
ONCE WEEKLY
TREATMENT IN HIV HEALTHY NOT
TAKINGANTI RETROVIRALTHERAPY

28. NON PHARMACOLOGICAL

29. NON PHARMACOLOGICAL
WHAT TO EAT
VEGETABLE WITH HIGH Fe+
& VIT B CONTENT
BRIGHT (RED)VEGETABLES
VEGETABLE OIL
WHOLE GRAIN
NOT TO EAT
ALCOHOL
TOBACO IN ALLFORM
SUGAR (REFINED PRODUCTS)
WHITE BREAD
HIGH FATDIET
HIGH CHOLESTEROL
RED MEAT

30. MYCOBACTERIUM
TUBERCULOSIS
RESISTANCE

31. MYCOBACTERIUM TUBERCULOSIS RESISTANCE
MDR TB
RIFAMPIN
ISONIAZID
XDR TB
ISONIAZID
RIFAMPIN
ANY
FLUOROQUINONE
ONE OF 3
INJECTIBLES
IMIKACIN
KANAMYCIN
CAPREOMYCIN

32. TREATMENT OF MDR TB
UTILIZEATLEAST 3-5
UNUSED DRUGS
LEVOFLOXACIN
DON’T ADD DRUG IN
FAILED REGIMEN
ADD 3 PREFFERABLE
MEDICINES FROM
FOLLOWING
AMINOGLYCOSIDE
FLUOROQUINONE
THIONAMIDE
CYCLOSERINE
BEDAQUILINE

33.  Treatment options are very limited
 Carries a very high mortality rate
TREATMENT OF MDR TB

34. DESIRED
OUTCOMES
RAPID IDENTIFICATION OF NEW CASESOF TB
INITIATION OF SPECIFICANTI TUBERSULOSIS TREATMENT
PROMPT RESOLUTION OF SIGNAND SYMPTOM OF
DISEASE
ADHERENCE THE TREATMENT REGIMEN BY THE PATIENT
CURE AS QUICKLY ASPOSSIBLE

35. THANK YOU

36. REFERENCE
https://reference.medscape.com/drug/rifadin-
rimactane-rifampin-342570
British National formulary (BNF)
https://emedicine.medscape.com/article/230802-
treatment#d12

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