TB, Leprosy & Diarrhea Flashcards
What drug is used for Latent/Asymptomatic infections and for how long
Isoniazid for 9 months
Rifampin for 4 months
Isoniazi+Rifampin for 3 months, once weekly
What is used for Overt/Active infection and for how long?
“2 with 4, then 4 with 2”
2 months treatment with combo of Rifampin+Isoniazid+Pyrazinamide+Ethambutol (RIPE). Next 4 months Riframpin+Isoniazid
What is used for intracellular TB and for how long
RIPE for 12 months+macrolide.
Discontinue Pyrazinamide after 2 months-hepatotoxic
What is the % chance of TB reactivation
5% in healthy
10% immunocompromised
How to treat reactivated TB and how long
“2 with 5, then 4 with 2”
2 months with RIPE plus Streptomycin
THEN 4 months with isoniazid and rifampin
Second line drugs can be added as needed-Amikacin, levofloxacin, linezolid, or Bedaquiline
What is the prophylaxis drug of choice for TB
Isoniazid
What does Isoniazid do?
Decreases mycolic acid synthesis and also releases free radicals when activated by the organism
Side effects of Isoniazid
Risk of hepatotoxicity
pyridoxine deficiency (give vitamin B6 to overcome)
Disulfiram-Like reaction
What is Pyrazinamide best used for and what does it require for activation
TB meningitis
Requires acidic pH to be activated
Side effect of Pyrazinamide
Hepatotoxicity-if used over 2 months guaranteed
increased uric acid (gout)
rash
Contraindicated in pregnancy- can cause sterility to mother and child
When is Ethambutol used?
Active TB infection, can cross blood brain barrier
Side effects of ethambutol
ocular toxicity
color blindness
ocular neuritis->blindness (6% patients within first 3 months). Can be reversed if stopped on first symptoms
What puts Multidrug resistant TB to bed
Bedaquiline
How is Bedaquinline administered and for how long
Orally once daily for 2 weeks, then 3 times per week for duration of treatment (22 weeks longer). Half life of 5-6 months
Side effects of Bedaquiline
nausea, vomiting, arthralgia (joint pain) and headache,
risk of prolonged QT syndrome
