L A R A N A , IN C .

ANTIMYCOBACTE
RIALS
PRESENTED BY: ALEXANDRA LORIN K. REYES
 ANTIMYCOBACTERI
ALS
Mycobacteria - the group of bacteria that
contain the pathogens that cause
tuberculosis and leprosy—are classifi ed on
the basis of their ability to hold a stain even
in the presence of a "destaining" agent such
as acid. Because of this property, t hey are
called "acid-fast" bacteria.
 MYCOBACTERIUM
TUBERCULOSIS

The bacterium Mycobacterium tuberculosis

causes tubercu-losis, the leading cause of death
from infectious disease in the world.
 MYCOBACTERIUM
LEPRAE
Mycobacterium leprae causes leprosy, also known as
Hansen's disease, which is characterized by
disfiguring skin lesions and destructive effects on the
respiratory tract. Leprosy is also a worldwide health
problem; it is infectious when the mycobacteria
invade the skin or respiratory tract of susceptible
individuals.
 ANTITUBERCULOSIS
DRUGS
Tuberculosis can lead to
serious damage in the
lungs, the GU tract, bones,
and the meninges.
Because M. tuberculosis is so
slowly growing, the treatment
must be continued for 6
months to 2 years.
 LEPROSTATIC DRUGS

The antibiotic used to treat leprosy is dapsone

(generic), which has been the mainstay of leprosy
treatment for years, although resistant strains are
emerging.
THERAPEUTIC ACTIONS
AND INDICATIONS
Most of the antimycobacterial agents act on the DNA
and/or RNA of the bacteria, leading to a lack of
growth and eventually to bacterial death. The
antituberculosis drugs are always used in
combination to affect the bacteria at various stages
and to help to decrease the emergence of resistant
strains.
 PHARMACOKINETICS

The antimycobacterial agents are generally well

absorbed from the GI tract. These drugs, given orally,
are metabolized in the liver and excreted in the urine;
they cross the placenta and enter breast milk, placing
the fetus or child at risk for adverse reactions.
 CONTRAINDICATIONS
AND CAUTIONS
Antimycobacterials are contraindicated for patients with any
known allergy to these agents; in those with severe renal or
hepatic failure, which could interfere with the m etabolism or
excretion of the drug; in those with severe CNS dysfunction,
which could be exacerbated by the actions of the drug; and in
pregnancy because of possible adverse effects on the fetus.
 ADVERSE EFFECTS

CNS effects, such as neuritis, dizziness, headache,

malaise, drowsiness, and hallucinations, are often
reported and are related to direct effects of the drugs
on neurons. These drugs also are irritating to the GI
tract, causing nausea, vomiting, anorexia, stomach
upset, and abdominal pain.
CLINICALLY IMPORTANT
DRUG-DRUG
INGERACTIONS
When rifampin and INH are used in
combination, the possibility of toxic
liver reactions increases. Patients should
be monitored closely.
 NURSING
CONSIDERATIONS FOR
PATIENTS RECEIVING
Antimycobacterials
 ASSESSMENT: HISTORY AND
EXAMINATION
• Assess for possible contraindications or cautions: • Perform a physical
known allergy to any antimycobacterial drug (obtain
specific information about the nature and occurrence of
examination to establish
allergic reactions); history of renal or hepatic disease, baseline data for assessing
which could interfere with metabolism and excretion of
the effectiveness of the drug
the drug and lead to toxicity; history of central nervous
system (CNS) dysfunction, including seizure disorders and the occurrence of any
and neuritis, which could be exacerbated by adverse adverse effects associated
drug effects; and current pregnancy status to ensure
with drug therapy.
appropriate drug selection to prevent adverse effects on
the fetus.
 ASSESSMENT: HISTORY AND
EXAMINATION
• Examine the skin for any rash or lesions
to provide a baseline for possible adverse
effects.
• Obtain specimens for culture and
sensitivity testing to establish the
sensitivity of the organism being treated.
• Evaluate CNS for orientation, affect, and
reflexes to establish a baseline and to
monitor for adverse effects.
• Note respiratory status to provide a
baseline for the occurrence of
hypersensitivity reactions.
• Evaluate renal and liver function
tests, including blood urea nitrogen
and creatinine clearance, to assess the
status of renal and liver functioning
so as to determine any needed
alteration in dose.
 NURSING DIAGNOSIS
Nursing Diagnosis related to drug therapy might include the following:

• Imbalanced nutrition: Less than • Acute pain related to GI effects

body requirements related to of the drug
gastrointestinal (Gl) effects • Deficient knowledge regarding
• Disturbed sensory perception drug therapy
(kinesthetic) related to
• CNS effects of the drug
 IMPLEMENTATION AND
RATIONALE
• Check culture and sensitivity reports to
ensure that this is the drug of choice
for this patient, and arrange repeated
cultures if response is not as
anticipated.
• Monitor renal and liver function test
results before and periodically during
therapy to arrange for dose reduction
as needed.
• Ensure that the patient receives the full
course of the drugs to improve effectiveness
and decrease the risk of development of
resistant bacterial strains. These drugs are
taken for years and often in combination.
Periodic medical evaluation and reteaching
are often essential to ensure compliance.
• Discontinue drug immediately if
hypersensitivity reactions occur to avert
potentially serious reactions.
 IMPLEMENTATION AND
RATIONALE
Provide the following patient teaching:
• Encourage the patient to eat small, frequent
meals as tolerated, perform frequent mouth • Try to drink a lot of fluids to
care, and drink adequate fluids to ensure maintain nutrition (very important)
adequate nutrition and hydra-tion. Monitor even though nausea, vomiting, and
nutrition if GI effects become a problem. diarrhea may occur.
• Instruct the patient about the appropriate dosage • Use barrier contraceptives and
regimen, use of drug combinations, and
understand that oral contraceptives
possible adverse effects to enhance patient
may not be effective if
knowledge about drug therapy and to promote
compliance antimycobacterials are being used.
 IMPLEMENTATION AND
RATIONALE
Provide the following patient teaching:

• Understand that normally some of these drugs impart an orange stain

to body fluids. If this occurs, the fluids may stain clothing and tears
may stain contact lenses.
• Report difficulty breathing, hallucinations, numbness and tingling,
worsening of condition, fever and chills, or changes in color of urine
or stool.
THANK
YOU!