Antimycobacterial Drug Study
Antimycobacterial Drug Study
Antimycobacterial Drug Study
tuberculosis and leprosy, are classified on the basis of their ability to hold a stain
even the presence of destaining agent such as acid. Because of this property, they
are called “fast acid bacteria”. The mycobacteria have an outer coat of mycolic acid
that protects them from many disinfectants and allows them to survive for long
periods in the environment. These slow growing bacteria may need to be treated for
several years before they can be eradicated.
Antituberculosis drug
Tuberculosis can lead to serious damage in the lungs, the GU tract, bones and the
meninges. Because M. Tuberculosis is so slow growing, the treatment muct be
continued for 6 months to 2 years. The first- line drugs for treating tuberculosis are
as follows:
• Isoniazid (INH) (Nydrazids) which affects the mycolic acid coating of the
bacterium
• Rifampin (Rifadin, Rimactane) which alters DNA and RNA activity in the
bacterium.
• Ethionamide (Trecator SC) which prevents cell division
• Rifapentine (Priffin), which alters DNA and RNA activity causing cell death.
These drugs are used in combination of two or more more agents until bacterial
conversion occurs or maximum improvent is seen.
If the patient cannot take one or more of these drugs, or if the disease
continues to progress because of the emergence of a resistant strain, the cond-line
drugs can be used:
These drugs are used in combination with at least one other antituberculosis
drug. If therapeutic success is still not achieved, a third line combination of two
antituberculosis drugs can be tried
Leprostatic Drug
Ciofazimine (Lamprene), which binds to bacterial DNA sites and causes cell
death, has been useful in the treatment of dapsone-resistant leprosy. The drug is
used as part of the initial leprosy treatment in combination with dapsone to prevent
the development of resistant strains.
Recently, the hypnotic drug thalidomide (Thalomid) was approved in use for a
condition that ccurs after treatment for leprosy.
Most of the antimycobacterial agents act on the DNA of the bacteria leading to a
lack of growth and eventually to bacterial death. INH specifically affects the mycolic
acid coat around the bacterium. Although many of the antimycobacterial agents are
effective against other species of susceptible bacteria, their primary indications are
in the treatment of tuberculosis or leprosy. The antituberculosis drugs are always
used in the 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,
metabolized in the liver and excreted in the urine. Caution should be used in
patients with hepatic or renal dysfunction, which could interfere with the
metabolism and excretion of the drugs. These drugs cross the placenta and enter
breast milk; they should be avoided during pregnancy and lactation unless the
benefit to the mother clearly outweighs the potential risk to the neonate.
Anitmycobacterial drugs are contraindicated for patients with any known allergy to
these agents; in those with severe renal or hepatic failure that could interfere with
the metabolism or excretion of the drug; in those with severe CNS dysfunction that
could be exacerbated by the actions of the drugs and in pregnancy because of
possible adverse effects on the fetus. If an antituberculosis regimen is necessary
during pregnancy, the combination of isoniazid, ethmabutol and rifampin is
considered the safest.
Adverse Effects
When rifampin and INH are used in combination, the possibility of toxic liver
reactions increases. Patient should be monitored closely.
Increased metabolism and decreased drug effectiveness occur as a result of
administration of quinidine, corticosteroid, oral contraceptives, oral antipropanolol,
oral anticoagulants, oral antidiabetic agents, digoxin, theophylline, methadone,
phenytoin, verapamil, cyclosporine, or ketoconazole, in combination with rifampin
or rifabutin. Patients who are taking these drug combinations should be monitored
closely and dosage adjustment as needed.
Nursing Managment’
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
anticipated.
Monitor renal and liver function test resilts before and periodically during therapy.
To arrange dosage reduction as needed.
Ensure that the patient receives the full course of the drugs. To improve
effectiveness and decrease the risk of development of resistand bacterial
strains. These drugs are taken for years and often in combination. Period
medical evaluation and reteaching are often essential to ensure
compliance.
Encourage the patient to eat small, frequent meals as tolerated; perform frequent
mouth care and drink adequeate fluids to ensure adequate nutrition and
hydration. Monitor nutrition if GI effects become a problem.