Tuberculosis drug therapy

Importance of skin testing and significance of a positive test Principles of preventive therapy for latent tuberculosis Drug therapy procedures for active tuberculosis Importance of notifying the facility... 

Those at risk of developing tuberculosis (eg, those with Hodgkin s disease, severe diabetes mellitus, leukemia, and other serious illnesses and those receiving corticosteroids or drug therapy for a malignancy)... 

Patients with M. tuberculosis meningitis should be treated for a duration of 9 months or longer with multiple-drug therapy, and patients with rifampin-resistant strains should receive 18 to 24 months of therapy. 

The three basic concepts in tuberculosis treatment are as follows (1) Regimens must contain multiple drugs to which the organism is susceptible. (2) Drugs must be taken regularly. (3) Drug therapy must con-... 

Nolan CM, Sandblom RE, Thummel KE, et al. Hepatotoxicity associated with acetaminophen usage in patients receiving multiple drug therapy for tuberculosis. 

Drug therapy has transformed tuberculosis from a disabling and often fatal disease into one in which almost 100% cure is obtainable, although the recent emergence of multiple drug resistant strains of Mycobacterium tuberculosis (MDRTB) in developed... 

Certain drug therapies (e.g. isoniazid) can lead to niacin deficiency. Isoniazid (the hydrazide derivative of isonicotinic acid) is the primary drug for chemotherapy of tuberculosis. 

A 42-year-old Asian man developed clinical, biochemical, and imaging features of acute pancreatitis 11 days after starting to take rifampicin, isoniazid, and pyrazi-namide for spinal tuberculosis (33). He had no history of excessive alcohol or other drug therapy. He improved after withdrawal of all drugs, but the pancreatitis recurred on reintroduction of isoniazid and resolved after withdrawal. 

Paradoxical reactions are often observed in patients with pulmonary and extra-pulmonary tuberculosis being treated with HAART. Clinicians need to distinguish these from other adverse reactions related to drug therapy. Reversal reactions in leprosy are increasingly likely as more patients with HIV infection are treated with HAART in developing countries. 

Capreomycin. — Because of low toxicity and remarkable activity against drug-resistant strains of M. tuberculosis, capreomycin, a polypeptide antibiotic, was recommended for use in multiple-drug therapy... 

Combination drug therapy is the rule to delay or prevent the emergence of resistance and to provide additive (possibly synergistic) effects against Mycobacterium tuberculosis. 

Another alkylamino derivative tested was a conjugate of streptomycin and isoniazid, another prominent anti-tuberculosis drug. This compound termed streptohydrazid, was synthesized and found to be at least as active as combined therapy using both streptomycin and isoniazid (51).Streptohydrazid was tested long before the mechanism of action of streptomycin was known (the mechanism of isoni-... 

Pyrazinamide is an important component of short-term (6-month) multiple-drug therapy of tuberculosis. The daily dose for adults is 15-30 mg/kg in a single oral dose. The maximum dose is 2 g/day regardless of weight. Children should receive 15-30 mg/kg/day daily doses also should not exceed 2 g. Pyrazinamide is safe and effective when administered twice or thrice weekly (at increased dosages). 

To delay resistance The combined use of drugs is valid in situations where the rapid emergence of resistance impairs the chances for cure. For this reason, combined drug therapy is especially important in the treatment of tuberculosis. 

Liver In 1809 HIV-infected adults who took nevirapine-based antiretroviral drug therapy the cumulative proportion of early hepatotoxicity was 1.0-2.0%, an incidence rate of 3.6-7.6 per 100 person-years [94 ]. The median time to hepatotoxicity was 32 days. At 12 weeks, only 8% of patients had alanine aminotransferase monitoring at all the times recommended by national guidelines. There was no association between early hepatotoxicity and age, sex, baseline CD4 count, concurrent tuberculosis infection, prior participation in a prevention of mother-to-child-transmission program, or baseline weight. There was no association between early hepatotoxicity and mortality. 

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