Describes mainly regarding the prophylaxis, treatment of tuberculosis

1. 1
PRESENTED BY:
CHALLA.ANITHA, Pharm-D student
Vignan Pharmacy College, Vadlamudi, Guntur

2. 2
After diagnosis we can conclude
whether it is
PULMONARY T.B EXTRA PULMONARY T.B
TREATMENT:
A longer period of treatment than the standard 6 months & the use of glucocorticoids is
needed for meningeal TB and pericardial T.B
Standard treatment regimen for respiratory and most other forms of TB:
•Rifampicin, Isoniazid, pyrazinamide & ethambutol for the initial 2 months (initial phase)
•Further 4 months of rifampicin & isoniazid (continuation phase).

3. Agent Activity Site of Action
Isoniazid (INH) Bactericidal Intracellular bacilli, extracellular
bacilli
Rifampin Bactericidal Intracellular bacilli, extracellular
bacilli, bacilli in caseous lesions
Pyrazinamide Bactericidal Intracellular bacilli
Streptomycin Bactericidal Extracellular bacilli
Ethambutol Bacteriostatic Intracellular bacilli, extracellular
bacilli
PRINCIPALACTIVITY & SITE OF ACTION OF MAJOR ANTI T.B AGENTS:
BACTERIAL CHARACTERISTICS:
• There are three populations of the M. tuberculosis (MTB) organism:
First population
Second population
Third population
Extracellular bacilli (pulmonary cavities within liquefied
Intracellular bacilli (inside macrophages)
Solid caseous material
caseous debris)
3

4. First-line drug therapy for fully-susceptible TB
4

5. DRUG BRAND NAME DOSING (MAXIMUM
DOSE)
PRIMARY SIDE
EFFECTS
Isoniazid
LANIAZID
Adults:5mg/kg(300mg)
daily;
15mg/kg(900mg)once,
twice,or thrice weekly
Children:10–
15mg/kg(300mg)
daily;20–
30mg/kg(900mg) twice
weekly
Increased
aminotransferases
(asymptomatic), hepatitis,
peripheral neuropathy,
CNSeffects, lupus like
syndrome,
hypersensitivity reactions
Rifampin
RIFADIN
RIMACTANE
Adults:10mg/kg(600mg)
once daily,
twiceweekly,or thrice
weekly Children:10–
20mg/kg(600mg)
oncedaily or
twiceweekly
Pruritus,rash,
hepatotoxicity,GI(nausea,
anorexia,abdominal
pain),flu like syndrome,
thrombocytopenia,renal
failure.Orange red
discolouration of body
secretions.
5

6. Pyrazinamide
ACTIZID
Adults:40–
55kg:1gdaily,2g
twiceweekly,1.5gthrice
weekly;56–75kg:1.5gdaily,
3gtwiceweekly,2.5gthrice
weekly;76–90kg:2gdaily,
4gtwiceweekly,3gthrice
weekly
Children:15–30mg/kg(2g)
daily;50mg/kg(2g)twice
weekly
Hepatotoxicity,
nausea,anorexia,
polyarthralgias,
rash, hyperuricemia,
dermatitis
Ethambutol
COMBUTOL,
MYAMBUTOL
Adults:40–
55kg:800mgdaily,
2gtwiceweekly,1.2gthrice
weekly;56–75kg:1.2gdaily,
2.8gtwiceweekly,2gthrice
weekly;76–90kg:1.6gdaily,
4gtwiceweekly,2.4gthrice
weekly
Children:15–20mg/kg(1g)
daily;50mg/kg(2.5g)twice
weekly
Loss of visual activity
skinrash,fever, Optic
neuritis.
6

7. Cycloserine
SEROMYCIN
Adults:10–15mg/kg/d(1g),
usually500–750mg/d in
two divided doses
Children:10–
15mg/kg/d(1g)
CNStoxicity
(psychosis,seizures),
headache,tremor,fever,skin
rashes
Ethionamide
TRECATOR-SC
Adults:15–20mg/kg/d(1g),
usually500–750mg/d in
one daily dose or two
divided doses
Children:15–
20mg/kg/d(1g)
GIeffects(metallictaste,nause
a,vomiting,anorexia,abdomi
nal pain),hepatotoxicity,
neurotoxicity,endocrineeffect
s (alopecia,gynecomastia,
impotence,hypothyroidism),
difficultyindiabetes
management
Streptomycin Adults:15mg/kg/d(1g);
≥60years,10mg/kg/d
(750mg) Children:20–
40mg/kg/d(1g)
Vestibularorauditorydysfunc
tion
ofeighthcranialnerve,renal
dysfunction,skinrashes,
neuromuscularblockade
7

8. Amikacin Adults:15mg/kg/d(1g);
≥60years,10mg/kg/d
(750mg) Children:15–
30mg/kg/d(1g)
Ototoxicity, nephrotoxicity
Capreomycin
CAPASTAT
Adults:15mg/kg/d(1g);
≥60years,10mg/kg/d
(750mg) Children:15–
30mg/kg/d(1g)as
singledoseortwice-weekly
dose
Nephrotoxicity, ototoxicity
p-Aminosalicylic
acid(PAS) TUBACIN
Adults:8–12g/dintwotothree
doses Children:200–
300mg/kg/din
twotofourdivideddoses
GI intolerance,hepatotoxicity,
malabsorption syndrome,
hypothyroidism
Levofloxacin
LEVAQUINE
Adults:500to1,000mg/d
Nausea,diarrhea,
abdominalpain,
anorexia,headache,dizziness,
QT prolongation,tendonpain
or rupture
Moxifloxacin
VIGAMOX Adults:400mg/d
Nausea,diarrhea,
abdominalpain,
anorexia,headache,dizziness,
QT prolongation,tendonpain
or rupture
8

9. MDRTB and possible effective treatments
9

10. XDRTB and diminishing options for therapy
10

11. CHEMOPROPHYLAXIS:
•The purpose is to prevent progression of latent tubercular infection to active disease.
•This is indicated only in :
Cases who show recent mantoux conversion.
Children with positive mantoux & a TB patient in the family.
Neonate of tubercular mother.
Patients of leukaemia, diabetes or those who are HIV positive, or on corticosteroid therapy
who show a positive mantoux.
Patients with old inactive disease who are assessed to have received inadequate therapy.
•Prophylaxis is usually with isoniazid alone for 6 months or rifampicin and isoniazid for 3
months.
•Without chemoprophylaxis, 40–50% of infants and 15% of older children with LTBI will
develop active TB disease in 1–2 years.
11

12. BCG VACCINE:
•BCG vaccine contains a live, attenuated strain derived from M. bovis.
It does not protect against infection, but it prevents more serious forms
of disease such as miliary TB and meningeal TB.
•Most age groups require a Mantoux test prior to being offered BCG vaccine.
DIRECTLY OBSERVED THERAPY (DOT):
• DOT, where the patient is observed taking their anti- tuberculous medication by a health
care professional, is not needed for most cases of active TB.
• In the latter, four drugs (isoniazid, rifampicin, pyrazinamide and either ethambutol or
streptomycin) are given daily for 2 months followed by rifampicin and isoniazid two or
three times weekly for the subsequent 4 months.
12

13. COUNSELLING POINTS:
•Patients taking rifampicin should be told that the drug will cause a harmless
discolouration of their urine and other body fluids, for example sweat and tears.
•Gas-permeable and hard lenses are unaffected.
•Women using the oral contraceptive pill should be advised to use other non-hormonal
methods of contraception for the duration of rifampicin treatment and for 8 weeks
afterwards as the effectiveness of hormonal contraceptives is reduced by rifampicin.
•Although ocular side effects are rare when ethambutol is taken in normal dosages,
patients should be warned of this potentially serious side effect.
•They should be advised to stop the drug and report to their doctor if they notice any
changes in vision, This is especially important because visual changes are usually
reversible on discontinuation of the drug but may be permanent if the drug is not stopped.
13

14. REFERENCES:
RODGER WALKER, CATE WHITTLESEA; Treatment & prophylaxis of tuberculosis;
Clinical pharmacy & Therapeutics; 5th Edition; p.g.no: 555-565
ERIC. T. HERFINDAL, DICK R. GOURLEY, HART; Treatment & prophylaxis of
tuberculosis; Clinical pharmacy & Therapeutics; 4th Edition; p.g.no: 727-738
BRAIN K. ALLDREDGE, ROBIN L. CORELLI, MICHAEL E. ERNST; Treatment &
prophylaxis of HIV & Opportunistic infections; Koda – kimble & Young’s applied
therapeutics, The clinical use of Drugs, 10th Edition, p.g.no: 1534-1558
14

15. 15