Katzung and Trevor’s Pharmacology Ch. 47

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

Multi-therapy
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

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

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

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

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

Ethambutol
Can cause eye disturbances

Pyrazinamide
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

Pyrazinamide
Useful because it has minimal X-resitance

Pyrazinamide
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

One
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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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