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Treatment of TB: Current Drugs in Use



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Treatment of TB Current Drugs in Use Adrian Gardner MD MPH Assistant Professor of Medicine Research Alpert Medical School of Brown University April 2011 Outline Principles First line drugs Fixed dose combinations Commonly used Second line drugs Other Second line drugs TB Drugs in Use First line Isoniazid Injectables Rifampin Rifabutin Streptomycin Kanamycin Ethambutol Pyrazinamide Quinolones Ofloxacin Other 2nd line Amikacin Levofloxacin Ethionamide Capreomycin Moxifloxacin Cycloserine PAS Linezolid Amox Clav Clofazamine Imipenem Clarithromycin Principles Combination therapy Eradicate TB infection Protect against resistance Prevent Relapse Weight based dosing All first line TB drugs are dosed based on patient s weight Directly Observed Therapy Limitations Lack of good information on pediatric pharmacokinetics Utility of serum drug levels First Line Drugs Isoniazid INH Mechanism Affects cell wall synthesis Bactericidal Dosing Adults 5 mg kg d to max 300mg d high dose 900 1500 mg twice thrice weekly Children 10 15 mg kg d to max 300mg d 20 30 mg kg dose twice thrice weekly Route oral IV IM Oral Preparations 50 100 300mg scored tablets 50mg 5ml solution sorbitol Metabolism Hepatic cytochrome p450 Adverse Reactions Hepatitis age related peripheral neuropathy hypersensitivity Common Drug Interactions Seizure meds phenytoin dilantin carbamazepine tegretol hepatotoxicity Special circumstances Safe during pregnancy breastfeeding Vitamin B6 pyridoxine supplementation Rifampin Mechanism inhibits protein synthesis Bactericidal Dosing Adults 10 mg kg d to max 600mg d Children 10 20 mg kg d to max 600mg d Route oral IV Oral Preparations 150 300mg capsules Metabolism Hepatic cytochrome p450 Adverse Reactions Rash pruritis orange body fluids hepatotoxicity hematologic GI upset flu like syndrome Common Drug Interactions Many HIV medications protease inhibitors oral contraceptives warfarin methadone corticosteroids Special circumstances Safe during pregnancy breastfeeding http www



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