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Anti-TB & anti leprosy drugs
1. Anti-TB & anti leprosy drugs
Dr. Karun Kumar
Senior Lecturer
Dept. of Pharmacology
2. Antitubercular Drugs
• First line High antitubercular efficacy & low
toxicity; are used routinely
• Second line Low antitubercular efficacy or higher
toxicity or both; used as reserve drugs
• First line Isoniazid (H), Ethambutol (E), Rifampin
(R), Streptomycin (S), Pyrazinamide (Z), Rifabutin,
Rifapentine
• Second line Ethionamide, FQs (CLOM), PAS,
Linezolid, Injectable drugs (Kanamycin, Amikacin,
Capreomycin)
5. • Group I Most potent and best tolerated oral drugs
• Group II Potent and bactericidal but injectable
drugs
• Group III FQs reserved for resistant TB
• Group IV Less effective for resistant TB
• Group V Uncertain efficacy; not to be used for
MDR-TB; but may be used for extensively drug-
resistant TB (XDR-TB)
6.
7. Isoniazid (H)
• Excellent antitubercular drug (tuberculocidal)
• Fast multiplying organisms are rapidly killed, but
quiescent ones are only inhibited
• MOA Inhibition of synthesis of mycolic acids
which are unique fatty acid components of
mycobacterial cell wall.
• Adverse effects NH (Neuritis, Hepatitis).
• Other side effects are lethargy, rashes, fever, acne
and arthralgia
8. Rifampin (Rifampicin, R)
• Bactericidal action covers all subpopulations of TB
bacilli, but acts best on slowly or intermittently
dividing ones (spurters)
• MOA Inhibits DNA dependent RNA synthesis
• RIF (Red discoloration of urine, Induction of liver
enzymes & its toxicity, Flu like symptoms);n,v,d
• Must be given empty stomach
• Other uses Leprosy, Prophylaxis of Meningococcal
and H. influenzae meningitis and carrier state
9. Pyrazinamide (Z)
• Weakly tuberculocidal; more lethal to intracellularly
located bacilli and to those at sites showing an
inflammatory response (pH is acidic at both these
locations)
• MOA Similar to INH
• A/E Pain in the joints (gout) due to hyperuricemia
Plus hepatotoxicity; Other adverse effects are
abdominal distress, arthralgia, flushing, rashes, fever
and loss of diabetes control
10. Ethambutol (E)
• Tuberculostatic and is active against MAC
• MOA Inhibit arabinogalactan synthesis thereby
interfering with mycolic acid incorporation in
mycobacterial cell wall
• A/E Eye toxicity (Loss of visual acuity/colour
vision, field defects due to optic neuritis); nausea,
rashes, fever, rarely peripheral neuritis;
hyperuricemia is due to interference with urate
excretion
11.
12. Treatment of tuberculosis
• 3-4 drugs under DOTS (Directly Observed Treatment
Short course)
• Goals :-
1. Kill dividing bacilli
2. Kill persisting bacilli
3. Prevent emergence of resistance
• Intensive phase (IP) 4–5 drugs lasting 2–3 months
aimed to rapidly kill the bacilli, bringing about
sputum conversion and afford fast symptomatic relief
13. • Continuation phase (CP) 2–3 drugs lasting 4–5
months during which the remaining bacilli are
eliminated so that relapse does not occur
16. Mycobacterium avium complex (MAC)
infection
• MAC is an opportunistic pathogen which causes
disseminated and multifocal disease in
immunocompromized (HIV-AIDS) patients
• Clarithromycin or Azithromycin is recommended for
prophylaxis of MAC inf. in pts. with CD4 count < 50
cells/μL
• Regimen 3 or 4 drug intensive phase of 2–6
months, followed by 2 drug maintenance phase for
at least 12 months
19. Antileprotic Drugs
• Dapsone Inhibits PABA incorporation into folic
acid by folate synthase; leprostatic
• Well tolerated at doses 100 mg/day or less.
• Other uses In combination with pyrimethamine,
dapsone can be used for chloroquine-resistant
malaria, toxoplasmosis and P. jirovecii infection
20. Adverse Effects
• Mild haemolytic anaemia is common
• Gastric intolerance—nausea and anorexia are
frequent in the beginning, decrease later
• Other side effects are methaemoglobinaemia,
headache, paresthesias, mental symptoms and drug
fever
• Cutaneous reactions include allergic rashes, fixed
drug eruption, hypermelanosis, phototoxicity
• Lepra reaction
21. Clofazimine
• Leprostatic; has antiinflammatory properties.
• MOA
1. Interference with template function of DNA in M.
leprae
2. Alteration of membrane structure and its transport
function.
3. Disruption of mitochondrial electron transport
chain
22. Adverse effects
• Skin Reddish-black discolouration of skin,
especially on exposed parts. Discolouration of hair
and body secretions may also occur. Dryness of skin
and itching is often troublesome. Conjunctival
pigmentation may create cosmetic problem
• GI symptoms Nausea, anorexia, abdominal pain,
weight loss and enteritis with intermittent loose
stools can occur
23. Rifampin
• Most potent cidal drug for M.leprae; rapidly renders
leprosy patients noncontagious.
• Upto 99.99% M.leprae are killed in 3–7 days by 600
mg/day dose.
• Shortens the duration of T/t
• Prev. dev. of resistance to Dapsone
24. Treatment of leprosy
• Leprosy is a chronic granulomatous infection caused
by Mycobacterium leprae; primarily affecting skin,
mucous membranes and nerves
Pt. has few bacilli (non-infective) Pt. has high bacillary load (infective)
Notas del editor
Revised National Tuberculosis Control Programme:
DOTS-Plus Guidelines (2010); Central TB Division,
Directorate General of Health Services, Ministry of
Health & Family Welfare, New Delhi
MAC is an opportunistic pathogen which causes disseminated and multifocal disease in immunocompromized (HIV-AIDS) patients. The disease develops when cell mediated immunity is markedly depressed, i.e. when CD4 count drops to <50 cells/μL, HIV-RNA load is high and other opportunistic infections (P. jirovecii, etc.) are also present. The newer macrolide antibiotics are particularly active drugs against MAC.
Glucose-6-phosphate dehydrogenase deficiency is a genetic disorder that occurs almost exclusively in males. This condition mainly affects red blood cells, which carry oxygen from the lungs to tissues throughout the body. In affected individuals, a defect in an enzyme called glucose-6-phosphate dehydrogenase causes red blood cells to break down prematurely. This destruction of red blood cells is called hemolysis.
G6PD helps red blood cells work. It also protects them from substances in the blood that could harm them
Methemoglobin (British: methaemoglobin) (pronounced "met-hemoglobin") is a hemoglobin in the form of metalloprotein, in which the iron in the heme group is in the Fe3+ (ferric) state, not the Fe2+ (ferrous) of normal hemoglobin. Methemoglobin cannot bind oxygen, which means it cannot carry oxygen to tissues.
Tingling or prickling, “pins-and-needles” sensation
Rel. of ags from killed bacilli