1. Side effects

2. Side effects: Isoniazid Rash, abnormal liver function, hepatitis, peripheral neuropathy and mild central nervous system (CNS) effects. Hepatitis The liver plays a central role to clear chemicals Isoniazid has a nitrogen group which is converted to an ammonium molecule when metabolized. The ammonium molecule can cause inflammation to the liver and results in hepatitis which can leads to fibrosis and cirrhosis

3. Side effects: Isoniazid Peripheral neuropathy damage to nerves of the peripheral nervous system side effects arise due to pyridoxine (vitamin B 6 ) depletion Pyridoxine is a water-soluble vitamin & a cofactor in reactions of amino acid metabolism that includes transamination, deamination and decarboxylation. Pyridoxine also plays a role in the enzymatic reaction to release glucose from glycogen.

4. Side effects: Rifampicin Hepatotoxicity Toxic liver disease and results from chemical driven liver damage Rifampicin promotes the upregulation of enzymes to increase the rate of metabolism of liver to clear out drugs, hence, hepatotoxicity may result in patients in adverse conditions. Since chemicals are cleared out at accelerated rates, under- treatment of other illnesses may result when other drugs are taken with rifampicin. Other side effects associated with rifampicin include fever, gastrointestinal disturbances and rashes.

5. Side effects: Pyrazinamide hepatotoxicity, joint pain, rash, sideroblastic anemia and intestinal nephritis. Sideroblastic anemia bone marrow produces sideroblasts, an abnormal nucleated erythroblasts, rather than healthy erythrocytes. Erythroblasts are precursors to mature red blood cells. Therefore, the body cannot incorporate iron into haemoglobin to allow red blood cells to transport oxygen efficiently. Intestinal neophritis Inflammation of the kidneys Reduces function of the kidneys causing them to fail or dysfunctiona

6. Side effects: Ethambol rash, itching, visual disturbances, peripheral neuritis which is the sensation of ‘pins and needles’ in hands and feet, decrease in the number of platelets in the blood, inflammation of the optic nerve which results in blurring of vision and colour blindness.

7. Administration: Rifater Rifater combination drug contains three active ingredients, rifampicin, isoniazid and pyrazinamide. Rifampicin inactivates the bacterial enzyme, RNA-polymerase. Without this enzyme the bacteria cannot reproduce and they die. Isoniazid prevents the tuberculosis bacteria from making mycolic acids, which are needed to form the cell walls of the bacteria. It also interferes with the cell metabolism of the bacteria by combining to the enzyme of the tuberculosis bacteria. Pyrazinamide kills tuberculosis bacteria that have infected cells.

8. Administration: Rifater There are two stages in the treatment for tuberculosis. In the first two months, tuberculosis treatment is aimed at killing as many bacteria as possible. Therefore, Rifater is usually used together with ethambutol for this first stage of treatment After the two months, treatment continues with only rifampicin and isoniazid for another four months to kill any remaining bacteria. Rationale: Bacteria can be targeted in different ways to increase the effectiveness of the treatment Combination treatment makes it less likely for bacteria to develop resistance to the treatment.