Drugs used for treatment of tuberculosis are classified into first line and second line on the basis of their efficacy, activity and risk of adverse reaction
Anti-tuberculosis drugsZ
- 1st line: (generally more safer and effective)
- ISONIAZID ,
- RIFAMYCINS (Rifampin, Rifapentin, Rifabutin),
- Pyrazinamide,
- Ethambutol,
Streptomycin may be used in severe cases of renal/milliary TB - Streptomycin is one of aminoglycosides. It is bactericidal . It is given by I.M injection - It is not 1st choice drug. - It used in combination with INH, rifampin & pyrazinamide for treatment of life – theatening TB & very ill patient eg. Milliary TB & renal TB (because50-90 % is excreted unchanged through the kidney) - Adverse effects includes ototoxicity
- 2nd line:
- Capreomycin,
- Ethionamide,
- Paraaminosalicylic acid (PAS),
- cycloserine,
- Others: Amikacin & Kanamycin, Clarithromycin, Linezolid, Azithromycin, Ciprofloxacin, Moxifloxacin, Levofloxacin
Antileprotics
REGIMEN OF THERAPY OF TB
The treatment has two phases of combination therapy: A) An initial intensive course for at least two months to reduce the number of bacilli as rapid as possible and avoid emergence of resistant strains. At least three drugs are used (INH; ISONIAZID + Rifampin + Pyrazinamide ), a fourth drug may be added if resistance is possible. The fourth drug may be Ethambutol or Streptomycin.
B) Continuation phase during which the number of bacilli is further reduced. ISONIAZID and Rifampin are used at least for 4 months. Ethambutol may be added if resistance is suspected.
- The previous regimen is used in uncomplicated pulmonary TB.
- Generally treatment depends on the type of the organism , site of lesion & severity of the disease.
- The course varies from 6-18 months.
- Long course is needed in cases of TB meningitis , bone , joint , kidney & some forms of lymph-adenopathy
TB and pregnancy:
The best therapeutic regimen is ISONIAZID and EthambutolZ . Rifampin is used only if TB is disseminated or very extensive. Streptomycin should not be used