Isoniazid Rifampin

The initial phase must contain three or more of the following drugp isoniazid, rifampin, and pyrazin-amide, along with either ethambutol or streptomycin. The CDC recommends treatment to begin as soon as possible after the diagnosis of tuberculosis. The treatment recommendation regimen is for the administration of rifampin, isoniazid, and pyrazinamide for a minimum of 2 months (8 weeks), followed by rifampin and isoniazid for 4 months (16 weeks) in areas with a low incidence of tuberculosis. In areas of high incidence of tuberculosis, the CDC recommends the addition of streptomycin or ethambutol for the first 2 months. 

Ms. Burns has received a diagnosis of tuberculosis. She is concerned because her primary health care provider has informed her that the treatment regimen consists of three drugs, isoniazid, rifampin, and pyrazinamide, taken for the next 2 months, followed by a 4-month treatment regimen with two of the drugs. 

Elevations of serum transaminase concentrations generally are not correlated with the residual capacity of the liver to metabolize drugs, so these markers cannot be used directly as guides for residual metabolic capacity. Hepatically cleared TB drugs include isoniazid, rifampin, pyrazinamide, ethionamide, and p-aminosalicylic acid.39 Ciprofloxacin is about 50% cleared by... 

Anti my cob ac t er ials Isoniazid Rifampin Ethambutol Pyriz inamide Streptomycin... 

The Centers for Disease Control and Prevention recommends a regimen of four drugs for empiric treatment of M. tuberculosis. This regimen should consist of isoniazid, rifampin, pyrazinamide, and ethambutol, 15 to 20 mg/kg/day (maximum 1.6 g/day) for the first 2 months generally followed by isoniazid plus rifampin for the duration of therapy. 

Isoniazid, rifampin, pyra- Seven days per week for 56 doses (8 weeks) la Isoniazid/rifampin Seven days per week for 126 doses (18 182-130(26 A(l) A (II)... 

Drugs of choice are isoniazid, rifampin, ethambutol, along with streptomycin and pyrazinamide. Less well tolerated, second-line agents include p-aminosal-icylic acid, cycloserine, viomycin, ka-namycin, amikacin, capreomycin, ethionamide. 

Drugs that may affect APAP include barbiturates, carbamazepine, hydantoins, isoniazid, rifampin, sulfinpyrazone, ethyl alcohol, and activated charcoal. 

The initial phase of the regimen must contain at least 3 of the following drugs Isoniazid, rifampin, and pyrazinamide, along with either ethambutol or streptomycin if the local resistance pattern to isoniazid is not documented or is greater than 4%. 

The current CDC recommendation for drug-susceptible initial treatment of active tuberculosis disease is a 6-month regimen consisting of isoniazid, rifampin, and pyrazinamide given for 2 months, followed by isoniazid and rifampin for 4 months. Treatment failure After treatment failure with other primary drugs in any form of active tuberculosis. 

Recommended for any form of active tuberculosis when treatment with first-line drugs (isoniazid, rifampin) has failed. Use only with other effective antituberculosis... 

Intended for use concomitantly with other antituberculosis agents in pulmonary infections caused by capreomycin-susceptible strains of Mycobacterium tuberculosis, when the primary agents (eg, isoniazid, rifampin) have been ineffective or cannot be used because of toxicity or the presence of resistant tubercle bacilli. Administration and Dosage... 

Streptomycin is indicated as a fourth drug in combination with isoniazid, rifampin, and pyrazinamide in patients at high risk for drug resistance. It is also used in the treatment of streptomycin-susceptible MDR tuberculosis. 

DNA synthesis inhibitors Fluoroquinolones Antimycobacterials Isoniazid Rifampin Ethambutol Pyrizinamide Streptomycin... 

M kansasii Resembles tuberculosis Ciprofloxacin, clarithromycin, ethambutol, isoniazid, rifampin, trimethoprim-sulfamethoxazole... 

Mycobacterium tuberculosis Isoniazid + rifampin + ethambutol + pyrazinamide Streptomycin, moxifloxacin, amikacin, ethionamide, cycloserine, PAS, linezolid... 

Tuberculosis Persons with positive tuberculin skin tests and one or more of the following (a) HIV infection, (b) close contacts with newly diagnosed disease, (c) recent skin test conversion, (d) medical conditions that increase the risk of developing tuberculosis, (e) age < 35 Isoniazid, rifampin, or pyrazinamide Excellent... 

During the initial phase, isoniazid is always used in combination with one other drug — rifampin, streptomycin, or ethambutol. In advanced or cavitary pulmonary tuberculosis, often three drugs are used — isoniazid, rifampin, and streptomycin or ethambutol. The pharmacological properties of the most often used drugs are summarized in Table 39.1. 

Isoniazid (INH), rifampin, pyrazinamide, ethambutol, and streptomycin are the five first-line agents for treatment of tuberculosis (Table 47-1). Isoniazid and rifampin are the two most active drugs. An isoniazid-rifampin combination administered for 9 months will cure 95-98% of cases of tuberculosis caused by susceptible strains. The addition of pyrazinamide to an isoniazid-rifampin combination for the first 2 months allows the total duration of therapy to be reduced to 6 months without loss of efficacy (Table 47-2). In practice, therapy is initiated with a four-drug regimen of isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin until susceptibility of the clinical isolate has been determined. Neither ethambutol nor streptomycin adds substantially to the overall activity of the regimen (ie, the duration of treatment cannot be further reduced if either drug is used), but they do provide additional coverage should the isolate prove to be resistant to isoniazid, rifampin, or both. Unfortunately, such resistance occurs in up to 10% of cases in the United States. Most patients with tuberculosis can be treated entirely as outpatients, with... 

Based on the patient s history and lab information, he was started on a regimen of isoniazid, rifampin, pyrazinamide, and ethambutol while waiting for definitive cultures. (Six weeks later, definitive culture results demonstrated growth of Mycobacterium tuberculosis.) The patient returned to the clinic complaining of blurred vision and an inability to differentiate between green and red colors. 

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