Atypical Antimycobacterium drugs

Question 1

MOTT (mycobacterium other than TB) are generally not sensitive to

Answer 1

many anti-TB regimens

Question 2

Rifabutin uses

Answer 2

Rifampin analog for single-agent prophylaxis of M. avium-intracellulare (MAC) in AIDS patients; recommended for those with low CD4 counts (<100/mm3)

Question 3

Rifampin analog for single-agent prophylaxis of M. avium-intracellulare (MAC) in AIDS patients; recommended for those with low CD4 counts (<100/mm3)

Answer 3

Rifabutin

Question 4

multi-drug treatment of MAC or other mycobacteria

Answer 4

Rifabutin

Question 5

Toxicities of Rifabutin

Answer 5

• Similar to rifampin but less frequent
• Most common are nausea and rash
• Drug interactions similar to rifampin, but a less potent CYP inducer

Question 6

part of multi-drug regimen for treatment of M. avium-intracellulare in AIDS patients and used for MAC prophylaxsis

Answer 6

Clarithromycin

Question 7

Bactericidal, even for intracellular forms and works Synergistic or additive in vitro with rifabutin or clofazimine

Answer 7

Clarithromycin

Question 8

M. avium-intracellulare (MAC; MAI)

Answer 8

Clarithromycin (or azithromycin) + ethambutol

(+ ciprofloxacin + rifabutin + clofazimine).

Question 9

Two major types - lepromatous and tuberculoid (localized)

and Endemic areas: Asia, Africa, South America, Phillipines, South Pacific Islands

Answer 9

Leprosy or Hansens disease

Question 10

Same as sulfonamides; structural analog of para-aminobenzoic acid (PABA); inhibits synthesis of folic acid
bacteriostatic

Answer 10

Dapsone

Is the ONE to use for leprosy

Question 11

Mechanism for Dapsone

Answer 11

inhibits synthesis of folic acid
bacteriostatic
Same as sulfonamides; structural analog of para-aminobenzoic acid (PABA);

Question 12

prophylaxis (& treatment) of Pneumocystis jiroveci (carinii) in AIDS patients

Answer 12

Dapsone

Question 13

•Dapsone is used in combination with other drugs (e.g. rifampin)
Who should use this?

Answer 13

therapy with multiple drugs for all leprosy patients

• Prophylaxis for leprosy contacts

Question 14

How is Dapsone metabolized?

Answer 14

Metabolized by the same enzyme which acetylates INH; slow and fast acetylators
• Metabolites excreted in urine
completely absorbed from GI tract
• Widely distributed to body fluids and tissues; especially concentrated in infected
skin`

Question 15

Adverse affects of Dapsone

Answer 15

Hemolytic anemia and methemoglobinemia

Question 16

Clofazimine mechanisms

Answer 16

binds to mycobacterial DNA interfering with reproduction and growth

Question 17

Uses of Clofazimine

Answer 17

combination chemotherapy, often for sulfone-resistant leprosy
• Also in combination therapy for M. avium-intracellulare in AIDS patients

Question 18

Bright red urine/GI well tolerated

Answer 18

Clofazimine

Question 19

Clofazimine adverse effects

Answer 19

Red urine/well tolerated. some GI

Question 20

Widely used in combination therapy (e.g. with dapsone)

Very active bactericidal antilepromatous drug

Answer 20

Rifampin

Question 21

Some Treatment Regimens for Leprosy

Answer 21

a. For lepromatous disease: dapsone + clofazimine + rifampin daily for 2 years
b. For tuberculoid disease: dapsone + rifampin daily for 1 year