10/10/2019

Revision BPIII
FINAL EXAM-TB
MRS F KATHRADA
8Q15

Intensive phase: 2 months

TUBERCULOSIS
Continuation phase: 4 months

Hepatitis (DILI)
First line agents: Rifampicin,INH,
Pyrazinamide
Second line: Ethionamide

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 10/10/2019

FIRST LINE TB AGENTS - RIPE

Drug MOA Rout Adverse effect Drug interactions Notes
e

Isoniazid Inhibits cell wall synthesis by oral - Peripheral neuropathy - Antacids(decr absorp) - Resistance: KatG
inhib. mycolic acid synthesis - hepatitis - cytP450 inhibitor mutation
(phenytoin,carbamazepin - Prodrug- conv by KatG
e, warfarin incr) (mycobaterial catalase
peroxidase)
- Used as IPT –
chemoprophylaxis in TB
close contacts- 6
months
Rifampicin Inhibits RNA synthesis oral - Discolours secretions red-orange INDUCER of cytP450: - Resistance: rpoB
- Rash Atazanavir/ritonavir, mutations
- GIT: N, V, D lopinavir/ritonavir, COC,
- Hepatitis warfarin, NNRTIs, itracon,……

Rifabutin Inhibits RNA synthesis oral Same as above * Less potent inducer of
cytp450- Preferred to
rifampicin in HIV pts taking
Protease inhibitors
Pyrazinamide Unclear oral - Joint pain-arthralgia Allopurinol, *pro-drug: conv by
Bactericidal for intracellular - Hyperuricaemia probenecid,diuretics pyrazinamidase
mycobacteria - hepatitis
Ethambutol Inhibits cell wall form. by oral - Ocular toxicity: blurred vision, colour diuretics * C/I: optic neuritis
inhibiting arabinosyl blindness
transferase - Hyperuricaemia, arthralgia

Second Line TB AGENTS

Drug MOA Route of Adverse effect Notes
administra
tion
Bedaquiline Inhibits mycobacterial oral - QT prolongation - Reserved for use in
ATPsynthase - hepatotoxic adults
- Half-life: 5.5 months

Delamanid Inhibits cell wall synthesis oral - QT prolongation * Useful in pts with HIV on
ART- no D/I
ethionamide oral - hepatitis hepatotoxic
- hypothyroidism
Cycloserine/terizidone - Neurologic & psychiatric
disturbances