1. Copyright (c) 2004 Elsevier Inc. All rights reserved. Antimycobacterial Agents: Drugs for Tuberculosis, Leprosy, and Mycobacterium avium Complex Infections Chapter 86

2. Copyright (c) 2004 Elsevier Inc. All rights reserved. Antimycobacterial Agents: Drugs for Tuberculosis, Leprosy, and Mycobacterium avium Complex Infections Tuberculosis –Mycobacterium tuberculosis –Person to person –Inhaled infected aerosol Screening –Tuberculin skin test (PPD) Diagnosis –Cytology –Chest x-ray

3. Copyright (c) 2004 Elsevier Inc. All rights reserved. Drug Resistance With Tuberculosis Goal of treatment –Eliminate symptoms –Prevent relapse Drug resistance –Contact—person with resistant TB –Repeated effectual courses of treatment

4. Copyright (c) 2004 Elsevier Inc. All rights reserved. Causes of Drug Resistance Principal cause underlying the emergence of resistance is inadequate drug therapy

5. Copyright (c) 2004 Elsevier Inc. All rights reserved. Treatment Regimens for Tuberculosis Two phases –Induction phases Eliminate active tubercle bacilli –Continuation phase Eliminate intracellular “persisters”

6. Copyright (c) 2004 Elsevier Inc. All rights reserved. Drug-Sensitive Regimen for Tuberculosis Induction phase 2 months Daily therapy –Isoniazid –Rifampin –Pyrazinamide –Ethambutol Continuation phase 4 months Daily or biweekly –Isoniazid –Rifampin

7. Copyright (c) 2004 Elsevier Inc. All rights reserved. Multidrug-Resistant Regimen for Tuberculosis Define –Resistance isoniazid and rifampin Treatment – Three drugs for 1 to 2 yrs Initial therapy –Isoniazid, Rifampin, Pyrazinamide,Ethambutol, Streptomycin

8. Copyright (c) 2004 Elsevier Inc. All rights reserved. Isoniazid (Laniazid) (INH) Primary agent Bactericidal Adverse effects –Peripheral neuropathy (pyridoxine vitamin B 6 ) –Hepatotoxicity –Optic neuritis –Anemia

9. Copyright (c) 2004 Elsevier Inc. All rights reserved. Rifampin (Rifadin) Broad spectrum antibiotic Uses –Tuberculosis –Leprosy –Haemophilus influenzae –Legionella Adverse effects –Hepatitis –Discoloration of body fluids

10. Copyright (c) 2004 Elsevier Inc. All rights reserved. Rifampin (Rifadin) (cont.) Drug interaction – Oral contraceptives – Warfarin – Drugs for HIV infection

11. Copyright (c) 2004 Elsevier Inc. All rights reserved. Ethambutol (Myambutol) Bacteriostatic Uses: tuberculosis Adverse effects –Optic neuritis –Allergy –Hyperuricemia

12. Copyright (c) 2004 Elsevier Inc. All rights reserved. Mycobacterium avium Complex Infection Mycobacterium avium complex –M. avium –M. intracellulare Prophylaxis –Azithromycin –Clarithromycin Acute infection –Same as prophylaxis plus ethambutol