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Ppt on antitubercular drug
- 1. ANTITUBERCULAR DRUGS Introduction (tuberculosis) • Tuberculosis is a chronic granulomatous disease caused by mycobacterium tuberculosis. • It is a major public health problem ; 5 lakhs people die in india every year due to this disease .after the spread of AIDS ,the problem has become more complex ,as tuberculosis and mycobacterium avium complex (MAC) infection are more common and rapidly progress in these patients.
- 2. ❑ DRUGS USED IN TUBERCULOSIS ❖ First line drugs 1. Isoniazid 2. Rifampicin 3. Pyrazinamide 4. Ethambutol 5. Streptomycin ❖ second lline drugs 1. Ethionamide 2. Amikacin 3. Ciprofloxacin 4. Rifabutin 5. Kanamycin 6. Rifapentine 7. Bedaquiline 8. cycoserine
- 3. FIRST LINE DRUGS ❑ Isoniazid ✓ Isoniazid is the most effective and cheapest primary antitubercular drug. ✓ It is tuberculocidal for rapidly multiplying bacilli but static for resting bacilli. ✓ Isoniazid destroys intracellular bacilli as it penetrates in to the cells ,i.e tubercle bacilli in macrophages ❖ Mechanism of action INH enters mycobecteria active form and bind enzymes decrease mycolic acid synthesis then cell wall weak tuberculocidal
- 4. ❑ ADVERSE EFFECT 1. Peripheral neuritis 2. Hepatitis 3. CNS Toxicity 4. Anorexia 5. Gastrointestinal discomfort 6. Fever 7. Allergic reactions and 8. Hemolysis
- 5. ❑ RECOMMENDED DOSES OF ANTITUBERCULAR DRUGS ▪ DRUGS ➢ Isoniazid ➢ Ethambutol ➢ Rifampicin ➢ Streptomycin ➢ Pyrazinamide ➢ Thiacetazone DOSES 300 – 400 mg 800 – 1000 mg 450 – 600 mg 750 – 1000 mg 1200 – 1500 mg 150 mg
- 6. ❑ SECOND LINE DRUGS ❖Thiacetazone ➢ Thiacetazone is tuberculostatic with low efficacy;it delays the development of resistance to other drugs and its low cost makes it a suitable drug in combination regiments. ▪ Side effects ➢ Hepatotoxicity ➢ Dermatitis ➢ Allergic reactions ➢ Gastrointestinal discomfort ❖ Ethionamide ➢ This tuberculostic drug is effective against both intra and extracellular organism. ➢ It is also effective in atypical mycobacteria . ➢ Anorexia, nausea,vomiting ,hepatitis, skin rashes and peripheral neuritis.
- 7. ❑ TREATMENT OF TUBERCULOSIS ➢ Tuberclosis is one of the most difficult infections to cure . ➢ The properties of the mycobacterium like slow division, development of resistance ,ability to remain as persisters for years and intracellular location of the bacilli have enhanced the problem. ➢ The aim of treatment is to kill the dividing bacilli thus making the patient sputum negative and to destroy the persister in order to prevent relapse and ensure complete cure. A combination of drugs is used in tuberculosis to; ❖ Delay the development of resistance ❖ Reduce toxicity ❖ Shorten the course of treatment
- 8. ❑ CHEMOTHERAPY IS GIVEN IN TWO PHASES: ❖ First phase – initial,intensive phase of 2-3 months duration aimed at killing as many bacilli as possible ❖ Second phase – continuation phase to destroy the persisters duration 4-5 months short-term therapy has rapid response,lower failure rates lesser chances of resistance and better patient compliance.
- 9. ❑ REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAM ➢ The govt of India along with the WHO and world bank has reviewed national TB program and has now the revised the strategy as Revised National tuberculosis control program (RNTCP) . ❑Directly obserbed treatment short course (DOTS)chemotherapy ➢ In India , it is implemented by the RNTCP. ➢ It involves providing most effective medicine and confirming that it is taken- a health worker ensures that the drug is taken by the patient.