Katzung and Trevor’s Pharmacology Ch. 47

Reason for use of drug combinations in TB TX
Delays or prevents the emergence of resistance

Used in TB mostly because of high amount of resistance (esp. to INH)

4-drug therapy
Commonly used in empirical TX for TB (INH, rifampin, pyrazinamide, ethambutol)

Streptomycin, amikacin, ciprofloxacin
Reserved for the resistant types of TB

Cycloserine, PAS, rifabutin
Alternative TB drugs if resistant to 4-drug therapy

Most commonly tested SE of INH
Peripheral neuropathy if no pyridoxine (B6) supplement

Can act like MAOI (inh. MAO); can cause serious HTN with tyramine

INH hepatotoxicity behavior
Is age-dependent (older are more susceptible)

Induces P450 (incr. CL of anticoag., ketoconazole, methadone, steroids in OCP)

MAC regimen of TX
Use a macrolide (clarithro., or azithro.), ethambutol, rifabutin

Can cause eye disturbances

Common side effect of this drug is polyarthralgia

Advised when young children are exposed to TB
Immediately start INH prophylaxis

Ethambutol MOA
Inhibits arabinosyl transferases

Useful because it has minimal X-resitance

SE of this drug is hyperuricemia (can precip. gout)

MAC prophylaxis regimen (AIDS pt.)
Weekly azithromycin or daily clarithromycin

MDR-TB (multi drug-res. TB)
Often correlated to areas with high INH resistance

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Tuberculosis Global epidemic caused by mycobacterium tuberculosis Treatment is prolonged making compliance and drug toxicity a problem. Active Tb: 6 months – 2 years Latent TB : treated with Isoniazid Qd 9 months Tuberculosis Drugs are: Isoniazid Rifampin Pyrazinamide ethambutol …

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Despite the development of effective treatment over four decades ago, tuberculosis is still one of the most prominent infectious causes of morbidity and mortality. Since the mid-1980s rates of tuberculosis have been increasing even in some industrialized countries such as …

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