pulmonary tb
DESCRIPTION
TUBERCULOSIS. Pulmonary TB. BY. PROF. AZZA EL- MEDANY. DR. SAID . OBJECTIVES. At the end of lecture , the students should: Discuss the etiology of tuberculosis Discuss the common route for transmission of the disease Discusses the out line for treatment of tuberculosis - PowerPoint PPT PresentationTRANSCRIPT
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Pulmonary TB
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BY PROF.
AZZA EL- MEDANY
DR.
SAID
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OBJECTIVES At the end of lecture , the students should: Discuss the etiology of tuberculosis Discuss the common route for transmission of the
disease Discusses the out line for treatment of tuberculosis Discuss the drugs used in the first & second line
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OBJECTIVES ( continue) Discuss the individual drugs regarding : The mechanism of action Adverse effects Drug interactions Contraindication Discuss tuberculosis & pregnancy Discuss tuberculosis & breast feeding
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EtiologyMycobacterium tuberculosis, an acid fast bacillus
with three types known to infect man causing pulmonary TB:The human type, commonestThe bovine typeThe africanum typeRecently, the three are identified as the mycobacterium
tuberculosis complex
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Robert Koch was the first to see Mycobacterium tuberculosis with his staining technique in 1882.
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•Each year, 1% of the global population is infected.
Disease information:
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Tuberculosis Common sites of infections Apical areas of lung Renal parenchyma Growing ends of bones
Where oxygen tension is high
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Treatment Of TuberculosisPreventing development of drug
resistance is the most important reason to use drug combination.
Periods of treatment ( minimum 6 months)Drugs are divided into two groups:1. First line 2. Second line
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Antimycobacterial drugsFirst line of drugs:Isoniazid (INH)RifampinEthambutolStreptomycinPyrazinamide
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Never use a single drug therapyIsoniazid –rifampin combination
administered for 9 months will cure 95-98% of cases .
Addition of pyrazinamide for this combination for the first 2 months allows total duration to be reduced to 6 months.
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IsoniazidBacteriostatic for resting bacilli.
Bactericidal for rapidly dividing bacilli.
Is effective against intracellular as well as extracellular bacilli
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Mechanism Of ActionIs a prodrug, activated by
mycobacterial enzymeInhibits the synthesis of mycobacterial
cell wall by inhibiting the synthesis of mycolic acid----
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Clinical usesMycobacterial infections .Latent tuberculosis in patients with positive
tuberculin skin test
Prophylaxis against active TB in individuals who are in great risk .
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Adverse effectsPeripheral neuritis (pin & needles sensation in the feet )Optic neuritis &atrophy.
(Pyridoxine{Vit.B6} should be given in both cases )
Hepatitis
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Drug Interactions of INH Enzyme inhibitor (inhibits the hepatic
microsomal enzymes especially cytochrome P450
.
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RifampinBactericidalInhibits RNA synthesis by binding to DNA dependent RNA
polymerase enzyme.
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Site of ActionIntracellular bacilliExtracellular bacilli
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Clinical usesMycobacterial infectionsProphylaxis of active tuberculosis.Treatment of serious staphylococcal
infections.Meningitis by highly resistant penicillin
pneumococci
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Adverse effectsHarmless red-orange discoloration of body
secretions .HepatitisFlu-like syndromeHemolytic anemia
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Drug InteractionsEnzyme inducer of hepatic microsomal
enzymes ( cytochrome P450)
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Ethambutol
Bacteriostatic
Inhibits mycobacterial cell wall synthesis ( Binds to arabinosyl transferase )
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Site Of ActionIntracellular & Extracellular bacilli
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Clinical usesTreatment of tuberculosis in combination
with other drugs.
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Adverse effectsImpaired visual acuity
red-green color blindness.
Ethambutol is contraindicated in children under 5 years.
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PyrazinamideProdrug.BactericidalMechanism of action is unknown .
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Site Of Action Active against Intracellular Bacilli
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Clinical usesMycobacterial infections mainly in
multidrug resistance cases.It is important in short –course (6 months)
regimen.Prophylaxis of TB .
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Adverse effectsHepatotoxicity
Hyperuricemia ( precipitate gouty arthritis )
Drug fever & skin rash
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Streptomycin
BactericidalInhibitors of protein synthesis by binding
to 30 S ribosomal subunits.Active mainly on extracellular bacilli
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Clinical usesSevere , life-threating form of T.B. as
meningitis, disseminated disease.
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Adverse EffectsOtotoxicityNephrotoxicityNeuromuscular block
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Indication of 2nd line treatment Resistance to the drugs of 1st line.Failure of clinical responseThere is contraindication for first line
drugs. Used in typical & atypical tuberculosis
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Ethionamide
Inhibits the synthesis of mycobacterial cell wall through inhibition of mycolic acid
synthesis
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Clinical usesAs a secondary line agent.
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Adverse Effects
Poorly tolerated Because of :Severe gastric irritation &Neurological manifestations
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Fluoroquinolones (Ciprofloxacin )Effective against multidrug- resistant
tuberculosis.
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Rifabutin RNA inhibitorCross –resistance with rifampin is
complete.Enzyme inducer for cytochrome P450
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Clinical usesEffective in prevention &treatment of T.B.
In prevention & treatment of atypical TB.
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Adverse EffectsGIT intolerance
Orange-red discoloration of body secretions.
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Aminosalicylic Acid (PAS).
Bacteriostatic
Inhibits Folic acid synthesis.
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Clinical usesAs a second line agent is used in the
treatment of pulmonary & other forms of tuberculosis.
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Adverse effectsGIT upset
Hypersensitivity reactions Crystalluria
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TB & Pregnancy Untreated TB represents a great risk to the
pregnant woman & her fetus than the treatment itself.
First line drugs are given for 9 months in normal doses
Streptomycin is the last alternative in treatment
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TB & Breast Feeding It is not a contraindication to receive drugs , but
caution is recommended
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