Transcript Isoniazid
PRINCIPLES AND METHODS OF TUBERCULOSIS THERAPY The main principles of tuberculosis therapy are the following ones: - - chapter covers the basic principles in the chemotherapy for tuberculosis. Current drug regimens recommended in the American Thoracic Society and Center for Disease Control and Prevention Statement' are presented. Special attention is given to drug interactions and intolerances. Issues specifically regarding HIV, multidrug resistant tuberculosis (MDR-TB), and nontuberculous (atypical) mycobacteria are covered in greater detail in other chapters. ORGANISM CHARACTERISTICS stopped. Bactericidal drugs should be used whenever possible. Drug regimens with two or more bactericidal drugs, including RIF, should be used when possible because this regimen results in the lowest relapse rates. However, drug resistance, intolerance, or drug interactions can make the use of two bactericidal drugs impossible. In these cases, it is necessary to add multiple bacteriostatic agents and treat for longer periods of time. • Actively Growing Extracellular Organisms DEVELOPMENT OF DRUG RESISTANCE ADHERENCE TO THERAPY • DRUGS • First-Line Drugs Isoniazid Liver function tests if baseline results are abnormal or if symptoms of adverse reactions occur Pyrazinamide Abnormal results for liver function tests; rash; gout Stomach upset; joint aches Liver function tests if baseline results are abnormal or if symptoms of adverse reactions occur; uric acid if joint symptoms occur Ethambutol Damage to the optic nerve; elevation of uric acidChanges in vision and color Rifampin Pyrazinamide Ethambutol Streptomycin Second-Line Drugs Rifabutin Ethionamide Cycloserine Para-Aminosalicylic Acid Clofazamine Aminoglycosides other than Streptomycin Quinolones Experimental Drugs—Rifapentene Drug Regimens Treatment Regimens Drug Interactions Drug Intolerance TABLE 4. Drug Interactions Isoniazid Alternative Routes of Administration Interruption of Therapy Monitoring Drug Levels Special Situations Drug-Resistant Tuberculosis Extrapulmonary Tuberculosis therapy, however. It is often more difficult to obtain tissue specimens for smear and culture from patients with extrapulmonary disease. Surgery may be necessary to obtain diagnostic specimens in some circumstances, such as constrictive pericarditis or spinal tuberculosis. Corticosteroids Immune Deficiency States Treatment in Children Pregnancy and Lactation Renal Dysfunction Drug Adjustment for Glomerular Filtration Rate (ml/min) Isoniazid Liver Dysfunction Malabsorptive States References • 4. Tsukamura M: In vitro antituberculosis activity of a new antibacterial substance ofloxacin (DL8280). Am J Respir Dis 1985;131:349-351.