5 - Antituberculosis & Antifungal Flashcards
What are properties of mycobacteria ?
- Immobile,Slow-grow,Gram +
- Contain lipid in cell walls called mycolic acids and
- Acid-fast bacilli
- Lipid-rich cell wall = impermeable to many agents.
- Can develop resistance, use drug combinations
- Intracellular pathogen , anti-TB drug need to penetrate until macrophages.
- slow response to antibiotics
Mycobacteria classification
- Mycobacterium tuberculosis complex (TB)
- NonTuberculousMycobacteria.
- Mycobacterium Leprae (Leprosy)
Duration of standard regimen for TB sensitive
- treatment in 6 months ( 2 intense , 4continuation)
Intensive treatment for TB sensitive
– Isoniazid (H)
– Rifampicin (R)
– Pyrazinamide (Z)
– Ethambutol (E)
Continuation treatment for TB sensitive
– Isoniazid (H)
– Rifampicin (R)
What is DOT and its purpose ?
Directly Observe Treatment,Ensuring compliance of patients that consume TB treatment.
Standard treatment regimen TB divided into 3 based on Diagnostic category which are ?
- Category 1 : New smear-positive patients; new smear- negative PTB/positive rongent with extensive parenchymal involvement; concomitant HIV disease or severe forms of extra-pulmonary TB.
- Category 2: Previously treated sputum smear-positive PTB (relapse/discontinue of treatment); treatment failure of category I
- Category 3 : New smear-negative PTB/positive rontgen mild illness; less severe forms of extra- pulmonary TB
- Insertion : (given to patients after 2 months regimen still have positive result)Sputum smear-positive on the last phase of treatment for new smear-positive patients of category I or smear-positive of retreatment of category 2
Regimen for category 1, 2, 3 and Insertion ?
- C1 : 2 HRZE/4 H3R3 = 2 months all anti-TB once daily & 4 months , 3 times a week consumption for isoniazid and rifampicin.
- C2 : 2 HRZES / 5H3R3E3 = 2 months anti-TB once daily via injection & 5 months 3 times a week consumption of isoniazid , Rifampicin , Ethambutol
or 1HRZE/5H3R3E3 - C 3 : 2HRZ/4H3R3
-Insertion : 1 HRZE
note : - front is intense & back is continuation , number = how many consumption per week
-letter reffer to name of drug in the intense and continuation treatment flash card.
Medicines recommended for Multiple Drug Resistance TB
Group A : Fluoroquionone
Group B : Second- line agents
Group C : Other core second-line agents
Groyp D : d1 , d2, d3
2 types of MDR-TB Treatment with confirmed rifampicin-resistant or MDR-TB
- Shorter MDR-TB Regimen
2. Individual (conventional) MDR/RR-TB regimens
Standard MDR TB Regimen (“conventional”) characteristic
- MINIMUM 20 MONTHS (6 mon intensive & 18 mon continuation)
- 6Z-(E)-Kn-Lfx-Eto-Cs/18Z-(E)-Lfx-Eto
- (E) & Z add on agents
- (E) not given if there is resistance occurs
How to read 6Z-(E)-Kn-Lfx-Eto-Cs/18Z-(E)-Lfx-Eto-Cs ?
6 months intensive treatment with the letter given and 18 months continuation treatment with the abbreviations letter
note. refer the letter to MDR treatment slide
Shorter MDR TB Regimen characteristic ?
1.Treatment duration of 9-12 months
2.Patients with rifamipicin resistance (RR) or MDR TB who have not been treated with 2nd line TB drug and who have not develop resistance to fluoroquinolone and anti-TB injection 2nd line
3.Standardized shorter MDR-TB regimen with seven drugs
4. 4-6 Km-Mfx-Pto-Cfz-Z-Hhigh-dose-E / 5 Mfx-Cfz-Z-E
– Exclusion criteria: extrapulmonary disease and pregnancy
FUNGI CHARACTERISTIC
- OPPORTUNISTIC MICROORGANISM
- CELL WALLS CONTAIN GLUCANS AND CHITIN
- INFECTION : SUPERFICIAL AND DEEP
Common Fungal Pathogen
- Dermatophytes
- Candida
- Aspergilus
- Cryptococcus
- Rhizopus
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Classification of Antifungal drug
- Systemic drugs ( amphotericin B , Flucytosine,Azoles,Echinocandins )
- Oral systemic ( Griseofulvin ,Terbinafine )
- Topical Drug ( Nystatin , Topical azoles , Topical allylamines )