Antimycobacterial drugs Tuberculosis Treatment of mycobacterial infections is complicated due: Limited information regarding antimycobacterial drug actions.

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Presentation transcript:

Antimycobacterial drugs Tuberculosis

Treatment of mycobacterial infections is complicated due: Limited information regarding antimycobacterial drug actions development of resistance The intracellular location of mycobacteria Chronic nature of the infection Patient compliance

Tuberculosis Supervised & unsupervised treatment Initial phase & continuation phase

Initial phase 2 months Isoniazid Rifampicin Pyrazinamide Ethambutol Streptomycin

Continuation phase 4 months Isoniazid rifampicin

Pregnancy and breastfeeding Children

Prevention of tuberculosis Reactivation of previously latent disease prophylaxis for close contacts

Monitoring Hepatic function Renal function (streptomycin & ethambutol)

Isoniazid INH cheap and highly effective Cornerstone in any treatment protocol

Mechanism of action Mycolic acid cell wall synthesis

Pharmacokinetics Oral administration Genetic control of acetylation

Side effects Neurotoxicity (pyridoxine) Hepatotoxicity Hemolysis

Rifampin (rifampicin) Essential drug for tuberculosis Antibacterial spectrum DNA-dependant RNA polymerase

Pharmacokinetics Oral administration Red orange excretions

Side effects Heptotoxicity Drug interactions –Contraceptive

Rifabutin AIDS M. avium complex

Ethambutol Arbinosyl transferase arabinogalactan

oral administration Renal excretion

Side effects Dose-dependant visual disturbance Snellen chart Reversible

Pyrazinamide Bacteriocidal active against growing intracellular dividing forms of M. tuberculosis Pyrazinoic acid First 2-3 months Tuberculosis meningitis

Side effects Nongouty polyarthralgia Hepatotoxicity

Streptomycin Ototoxicity Nephrotoxicity

Alternative drugs Less effective More serious side effects

Alternative drugs Amikacin Ciprofloxacin and ofloxacin Ethionamide (GIT and neurological) P-aminosalicylic acid

Leprosy (M. leprae) Triple therapy Dapsone Clofazimine Rifampin 6-24 months

Dapsone Structurally related to sulfonamide M. leprae Pneumocyctis jiroveci Folate biosynthesis S.E: hemolysis

Clofazimine DNA replication Red brown discoloration of the skin Anti-inflammatory effects