This is about Updated Regimen for treatment of Tuberculosis

1. AASHISH LAMICHHANE
COLLEGE OF MEDICAL
SCIENCES
NEPAL
TREATMENT
REGIMEN
OF
TUBERCULOS
IS

2. CONTENTS
• INTRODUCTION TO TUBERCULOSIS
• FIRST LINE DRUGS:
• ISONIAZID
• RIFAMPICIN
• PYRAZINAMIDE
• ETHAMBUTOL
• SECOND LINE DRUGS
• DRUG REGIMEN

3. INTRODUCTION
• Tuberculosis is chronic granulomatous
inflammatory disease especially caused by
Mycobacterium tuberculosis.
• It is one of the most common disease mostly
in South Asian countries like Nepal and
India.

4. FIRST LINE DRUGS
•ISONIAZID (H)
•RIFAMPICIN (R)
•PYRAZINAMIDE (Z)
•ETHAMBUTOL (E)

5. 1. ISONIAZID (H)
• Isoniazid is the primary drug for chemotherapy of
tuberculosis.
• It can kill both intracellular and extracellular bacilli.
• All those who can tolerate isoniazid should receive the drug.

7. ADVERSE EFFECT
Hepatotoxicity
Peripheral Neuropathy
Neurological manifestations (Mental disturbance,
numbness)
Allergy

8. 2.RIFAMPIN (R)
• It is bactericidal drug.
:
• Rifampin binds to ß-subunit of DNA-dependent RNA
polymerase and forms stable drug-enzyme complex
which inhibits RNA synthesis.

9. ADVERSE EFFECT
Hepatitis
Abdominal cramps , Nausea , Vomiting , Diarrhoea
Flu like symptoms – chills , fever , headache
Red/Orange discoloration of secretion

10. 3. PYRAZINAMIDE (Z)
• It is bactericidal drug.
• It is weakly tuberculocidal.

11. PYRAZINAMIDE
Pyrazinamidase ( PncA gene)
PYRAZINOIC
ACID
MYCOLIC ACID
SYNTHESIS

12. ADVERSE EFFECT
Dose dependent Hepatotoxicity
Hyperuricemia- which may lead to gout
Arthralgia

13. 4. ETHAMBUTOL (E) :
• It is bacteriostatic
Arabinosyl transferase (embAB) is involved in arabino -
galactan synthesis.
Ethambutol inhibits the Arabinosyl transferase and hence
interfere with mycolic acid incorporation in mycobacterial cell
wall.

14. ADVERSE EFFECT
Optic neuritis causing loss of visual activity
Red Green colour blindness
Hyperuricemia
Nausea

15. SECOND LINE DRUGS
•Kanamycin
•Amikacin
•Fluoroquinolones
•Cycloserine
•Ethionamide

16. DRUG REGIMEN
Once the decision is made to initiate treatment for
tuberculosis, the patient should be classified according to:
i. Site of TB disease (Pulmonary or Extra Pulmonary)
ii. Bacteriological confirmation status (bacteriologically
confirmed or clinically diagnosed)
iii. Previous TB treatment status if any (new or
retreatment)

17. After classifying, patient is treated with specific drug
therapy.
The chemotherapy of TB contains 2 phases:
- Intensive phase
- Continuation phase

18. INTENSIVE PHASE
• 2-3 months duration
• Minimum of 4 drugs given for rapid killing of bacilli
CONTINUATION PHASE
• 4 to 10 months
• Usually 2 drugs given for eliminating remaining bacilli
and prevent relapse.

19. Type of TB Intensive
Phase
Continuation
phase
NEW TB CASES
All forms:
-adulthood and childhood
-bacteriologically or clinically
. diagnosed
-Pulmonary or Extra
Pulmonary
2 HRZE 4 HR
NEW TB CASES
(Severe form)
CNS TB, TB pancarditis,
Millary …TB, Musculoskeletal TB
2 HRZE 7-10 HRE

20. Type of TB Intensive
Phase
Continuation
Phase
Retreatment cases
All forms:
1st Rapid DST with
Xpert MTB/RIF testing
should be done to see
the status of resistance
to Rifampicin
Followed by LPA among
those having MTB +ve
and Rifampicin
sensitive for Isoniazid
(INH) resistance status.
Xpert MTB/Rif: Rifampicin
sensitive
LPA: Isoniazide sensitive
2HRZE 4HR
Xpert MTB/RIF:
Rifampicin sensitive
LPA: Isoniazide Resistant
6RZE + Levofloxacin
(Full Duration)
Xpert MTB/Rif– Rifampicin
sensitive
LPA – Isoniazid Not known
because of no access to LPA
6 HRZE (Full
Duration)
Rifampin sensitive,
Isoniazid resistant and FQ
resistant
6RZE

21. DRUG RECOMMENDED DOSAGE
Daily(mg/kg) >50kg
Isoniazide 5 300 mg
Rifampin 10 600 mg
Pyrazinamide 25 1500 mg
Ethambutol 15 1000 mg

22. THANK