Tuberculosis is potentially fatal, contagenous and chronic disease,that can effect any part of the body but is mainly an infections of their lungs.It is also a granulomatous disease. It is mostly seen in Africa and Asia. This tuberculosis is of 2 types - mycobacterium tuberculosis and pulmonary tuberculosis. 1) If lungs are affected that is pulmonary tuberculosis 2) If other than lungs are affected, it is extra pulmonary CONTENTS -Defniton -Etiology -Transmission -Signs and Symptoms -Pathophysiology -Diagnosis -Goals of therapy -Drug interactions

1. PHARMACOTHERAPEUTICS
TOPIC: TUBERCULOSIS
D.PRIYA CHANDANA
VIGNAN PHARMACY COLLEGE
VADLAMUDI
TUBERCULOSIS
DEFINITION: Tuberculosis is a potentially fatal contagious
disease that can be affect almost any part of the body but is
mainly an infections of the lungs
 It is also known as granulomatous disease
 It more seen in Africa,asia
 Mycobacterium tuberculosis,pulmonarytuberculosis
 If lungs are effected –pulmonary

2.  Mycobacterium avium complex-IIIV /immunocompressive
[MAC]
 Other than lungs-extra pulmonary
 May occur at any age
ETIOLOGY :
1. Causative organisams : mycobacterium
tuberculosis – humans ,mycobacterium
bovius- animals
2. Others- m.aficanum,m.ovium,m.canetti
TRANSMISSION :
 Contaminated through food and water
 By sharing utensils ,cigerettes
 By shaking hands[ causualcontact]
 Using publictelephone
SIGNS AND SYMPTOMS :
1. Chronic cough with blood tinged sputum [ hemoptosis ]

3. 2 . fever ,chills
3. weight loss
4. fatigue
5. swollenglands
6. loss of appetite
7. pleuritic pain
8. malaisepain
PATHOPHYSIOLOGY:
Injury [ when exposure to source – m.tb ]
ENTRY
Failure to digest the foeigh body
Weak acute inflammatory response

4. Persistence of injurious agents
T-cells mediated poorly digest
Immune response agent
Activationof CD4 T-Cells [ release of IL -1,IL-2
Growth factors INFα, INFδ]
Chemotacticfactor
Accumulation of tissue macrophages in blood and which
will proliferation
These macrophages are activated by TNF α
These macrophages are transformed to
epitheiloid cell and cell formation

5. Granuloma
tuberculosis
DIAGNOSIS :
 Sputum for acid fast bacillus – early
morning
 Chest x – ray
 Mantouse test [ purified protein
derivatives]
 CBP-Completeblood picture
 Zeil-neelsons staining
 Fluorescence staining
PHARMACOTHERAPYOF TB [ACCORDING TO RNTCP
GUIDELINES] :
Tuberculintest is performed , 5 – tuberculin
units shouldbe taken “ revised nationaltuberculosiscontrol
programme”
GOALS OF THERAPY :
TREATMENTFOR LATENT TB :

6.  Asymptomatic will no hiv
infection [ HIV –Ve]
 INH – Isotonic acid
hydrazine – 300 mg / day -6
to 9 months , Rifampacin –
600 mg / day – 4 months
 DRUG COMBINATION;
rifampacin – 900 mg + INH
– 900 mg / week – for 12
 INM – per 9 months /
monotherapy – 300mg
TREATMENTFOR ACTIVE TB INFECTION WITH NO HIV :
Symptomatic TB or pulmonary TB with no HIV
infection 4 drug regimen must used
R – rifampacin – 10mg / kg
H- Isoniazide – 5 mg for 4 months
E – Ethambutol – 30 mg
Z – Pyrazinamide – 35 mg
R,H,E,Z – 4 Months , R,H – 2 Months
TREATMENTFOR ACTIVE TB WITH HIV INFECTION :
R,H,E,Z – 4 Months, R,H – 2 months

7. 2 drugs are – rifabutin,isoniazide
If patient with hiv are treated with protease inhibitory
[ritnovir], nucleosidereverse trancecriptace inhibitoryin such
cases rifampacin is replaced with rifabutinbecause rifampacin
easily metabolises the hiv drugs and also leadsto dry ,also
replace rifampacin after some period of time weeks after the
elimationof metabolitesof rifampacin
TREATMENTFOR TB IN PREAGNENT WOMEN :
Duration of therapy – 9 months
3 days regimen – for 2 months – R,H,E was given
For 7 months – R,H was given
TREATMENTFOR TB IN RENAL FAILURE / RENAL IN
CANDIDATES :
While prescribing rote of elimination isand drug
which have non renal route of eliminationprescribed
Rifampacin
Isoniazide
Pyrozinamide
Ethambutolis contra indicatedbecause it is through kidney
[renal clearance] if ethambutol is necessary dose reduced and
given to the patient

8. TREATMENTFOR TB IN LIVER FAILURE :
All TB drugs have hepatotoxicity in liver
failure enzymes like AST , ALT increases so , the activity of drugs
must be monitored
DRUGS : R,H 2 dose decrease frequency increase for 2 months
After 2 months if level of enzymes increases stop the therapy
for normal levels : 30 IU / L
If with in 2 months level increases and restart treatment when
enzyme levels become normal
INH side effects : peripheral nephritis
So INH and vit B6 should be given [B6 dose – 25-50 mg ]/ day to
treat peripheral nephritissometimes streptomycin [ 15 mg / kg
/ day]is added
DRUG INTERACTION WITH “ ANTI TB DRUGS” :
 Ethambutol+ al[oh]3 – complex formation , decrease
absorbtionof ethambutolconcomittent use in encouraged
 Isoniazide + thiophilline/ carbamazepine / phenytoin
/disulfurin - decrease the levels of isoniazide
 Isoniazide + Rifampicin – increase the chance of
hepatotoxocity
 Pyrazinamide + Allopurinol – increase the pyrazinamide
levels ( toxicity)