2. Antimycobacterial drugs Tuberculosis

3. 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

4. Tuberculosis Supervised & unsupervised treatment Initial phase & continuation phase

5. Initial phase 2 months Isoniazid Rifampicin Pyrazinamide Ethambutol Streptomycin

6. Continuation phase 4 months Isoniazid rifampicin

7. Pregnancy and breastfeeding Children

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

9. Monitoring Hepatic function Renal function (streptomycin & ethambutol)

10. Isoniazid INH cheap and highly effective Cornerstone in any treatment protocol

11. Mechanism of action Mycolic acid cell wall synthesis

12. Pharmacokinetics Oral administration Genetic control of acetylation

13. Side effects Neurotoxicity (pyridoxine) Hepatotoxicity Hemolysis

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

15. Pharmacokinetics Oral administration Red orange excretions

16. Side effects Heptotoxicity Drug interactions –Contraceptive

18. Rifabutin AIDS M. avium complex

19. Ethambutol Arbinosyl transferase arabinogalactan

20. oral administration Renal excretion

21. Side effects Dose-dependant visual disturbance Snellen chart Reversible

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

23. Side effects Nongouty polyarthralgia Hepatotoxicity

24. Streptomycin Ototoxicity Nephrotoxicity

25. Alternative drugs Less effective More serious side effects

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

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

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

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