Professional Documents
Culture Documents
BS Pharmacy - 4
TUBERCULOSIS
• is an airborne bacterial infection caused by the
organism Mycobacterium tuberculosis.
• It mainly affect the lungs but can damage any part of the body
such as the kidney, spine, and brain.
•HIV • Smoking
•Uncontrolled diabetes mellitus •Chemotherapy
• Sepsis renal failure • organ transplantation, and
•Malnutrition • long-term corticosteroid usage
TUBERCULOSIS DISEASE
• The tubercle bacilli overcome the immune system and
multiply, resulting in progression from LTBI to TB
disease.( TB bacteria are active)
• It is most common in infants and children younger than 5 years of age, and
in severely immunocompromised persons.
RISK GROUPS
Persons with medical conditions that weaken the immune system
Persons who have been recently infected with TB bacteria
Close contacts of patients with TB, especially those with sputum
smear-positive pulmonary disease
Groups with high rates of TB transmission, such as homeless
persons, injection drug users, and persons with HIV infection
Persons who work or reside with people who are at high risk for TB
in facilities or institutions such as hospitals, homeless shelters,
correctional facilities, nursing homes, and residential homes for
those with HIV
Impact of HIV Infection
• People with HIV infection have an increased risk of developing TB if exposed to
infection.
• The estimated annual risk of TB in those with HIV infection and TB co-infection is
around 10% as opposed to a 10% lifetime chance in someone infected with TB, but
not HIV.
• Someone with untreated latent TB infection and HIV infection is much more likely
to develop TB disease during his or her lifetime than someone without HIV
infection.
• Among people with latent TB infection, HIV infection is the strongest known risk
factor for progressing to TB disease.
• A person who has both HIV infection and TB disease has an AIDS-defining
condition.
Drug-resistant TB
• Multidrug-resistant tuberculosis (MDR-TB) caused by bacteria that
do not respond to isoniazid and rifampicin, the 2 most powerful, first-line
anti-TB drugs.
• MDR-TB results from either primary infection with resistant bacteria or
may develop in the course of a patient’s treatment.
• MDR-TB is treatable and curable by using second-line drugs.
• However, second-line treatment options are limited and require extensive
chemotherapy (up to 2 years of treatment) with medicines that are
expensive and toxic.
• Extensively drug-resistant tuberculosis (XDR-TB): caused by
bacteria that are resistant to isoniazid and rifampicin
DIAGNOSIS
The symptoms and signs of TB include:
• Rifampicin is the only drug that is bactericidal against all three populations.
• Aminoglycoside
• Bacteriostatic
Blocks 23s
Used in combination with second and third line drugs for patients with
tuberculosis caused by multidrug-resistant strains
irreversible peripheral
optic neuropathy
Immunocompromised patients
• Should be treated with normal first-line agents unless multidrug-resistant TB is
suspected
• These patients have a greater risk of relapse and may need to be treated for longer
than the normal 6 months.
TREATMENT OF TB IN
SPECIAL CIRCUMSTANCES
Pregnancy
• Standard therapy should be given, although streptomycin
should not be used as it may be ototoxic to the fetus.
• Pyridoxine (Vitamin B6) supplementation (10-25mg/day)
is recommended for breastfeeding women taking
isoniazid.
• Patient should be warned of the reduced effectiveness of
oral contraceptives in regimens containing rifampicin,
and advised to use other, non-hormonal contraceptives.
TREATMENT OF TB IN
SPECIAL CIRCUMSTANCES
Renal Disease
• May be given isoniazid, rifampicin and pyrazinamide in standard
doses as these drugs are predominantly eliminated by non-renal
routes.
• Ethambutol undergoes extensive renal elimination and therefore
dose reduction is needed.
• Streptomycin must be used with considerable caution to prevent
toxicity and is best avoided in renal failure.
• Rifampicin may be given in standard doses to patient on dialysis.
TREATMENT OF TB IN
SPECIAL CIRCUMSTANCES
Liver disease
Drug-resistant TB
Health Care Workers. BCG vaccination of health care workers should be considered on an
individual basis in settings in which
• A high percentage of TB patients are infected with M. tuberculosis strains resistant to both
isoniazid and rifampin;
• There is ongoing transmission of such drug-resistant M. tuberculosis strains to health care
workers and subsequent infection is likely; or
• Comprehensive TB infection-control precautions have been implemented, but have not been
successful.
CONTRAINDICATIONS
Immunosuppression.
Pregnancy.