Group 1: First-line oral drugs Group 2: Injectables Group 3: Fluoroquinolones Group 4: Other second-line drugs Group 5: Possible reinforcing drugs (drugs with unclear efficacy), The five drug groups • Group 1: First-line oral drugs • Group 2: Injectables • Group 3: Fluoroquinolones • Group 4: Other second-line drugs • Group 5: Possible reinforcing drugs (drugs with unclear efficacy) An MDR-TB treatment regimen requires the use of at least four active medications against TB (but often involves five), Kanamycin (Km) Group 2 — Injectable • Aminoglycoside • Interferes with protein synthesis through disruption of ribosome Dose: 1 g IM/IV (15-20 mg/kg) Side effects: • Nephrotoxicity • Ototoxicity • Electrolyte wasting Adjust dose for renal failure, Amikacin (Amk) Group 2 — Injectable • Aminoglycoside • Highly similar to kanamycin (can be essentially considered the same drug) Dose: 1 g IM/IV (15-20 mg/kg) daily Side effects: • Same as kanamycin; renal failure and ototoxicity High cross-resistance with kanamycin Adjust dose in renal failure (same as kanamycin), Capreomycin (Cm) Group 2 — Injectable • Polypeptide • Structurally and functionally similar to aminoglycosides Dose: 1 g IM/IV (15-20 mg/kg) daily Side effects • same as Km/Amk Some cross-resistance with Km/Amk Adjust dose for renal failure, Ofloxacin (Ofx) Group 3 — Fluoroquinolone • Inhibits DNA-gyrase Dose: 800 mg daily Side effects • Generally well-tolerated • GI upset, rash, CNS disturbance Avoid antacids around time of ingestion (reduces absorption) Near complete cross-resistance with other fluoroquinolones, Levofloxacin (Lfx) Group 3 — Fluoroquinolone Dose: 750 mg daily for <50 kg (1000 mg daily for > 75kg) • A higher dose for tuberculosis is used than for other infections Side effects • Generally well-tolerated • GI upset, rash, CNS disturbance Adjust dose in renal failure, Moxifloxacin (Mfx) Group 3 — Fluoroquinolone • May be more active than earlier generation quinolones Dose: 400 mg daily Near complete cross-resistance with other fluoroquinolones • Moxifloxacin may have limited efficacy against some strains resistant to ofloxacin No dose adjustment in renal failure • Hepatically cleared, Ethionamide (Eto) Group 4 — Other second line drugs • Derivative of isonicotinic acid (same family as isoniazid) Dose: 500-1000 mg daily in divided doses Side effects • GI upset, hypothyroidism, peripheral neuropathy Partial cross-resistance with isoniazid, complete with prothionamide Hepatically excreted Co-administer vitamin B6, Prothionamide (Pto) Group 4 — Other second line drugs • Structurally similar to ethionamide Dose: 500-1000 mg daily in divided doses Overall side effect profile similar to ethionamide • Slightly less GI side effects Complete cross-resistance with ethionamide, Cycloserine (Cs) Group 4 — Other second line drugs • Alanineanalogue • Interferes with cell-wall proteoglycan synthesis Dose: 500-1000 mg daily in divided doses Side effects: • Seizures, psychosis, depression, irritability, headache Renally excreted Effective CNS penetration Co-administer B6, Terizidone (Trd) Group 4 — Other second line drugs • Structure is composed of two connected molecules of cycloserine • Commonly used in South Africa in place of cycloserine Dose: 500-1000 mg daily in divided doses Possibly less side effects than cycloserine Not yet recommended by the WHO • There is less information on terizidone than cycloserine and no direct studies comparing the two, Para-aminosalicylic acid (PAS) Group 4 — Other second line drugs • Various formulations; delayed-release microcapsules (PASER) best tolerated Dose of PASER is 4 g (1 sachet) twice daily Side effects • GI upset, hypothyroidism • Hepatitis, electrolyte abnormalities Hepatic metabolism, renal excretion Administer with acidic food or drink, Group 5: Possible reinforcing agents Minimal clinical data to support use in MDR-TB therapy. For clinical isolates, gyrB mutations appear to be of much rarer occurrence [72, 73]. The fluoroquinolones (FQs) have broad-spectrum antimicrobial activity and so are widely used for the treatment of bacterial infections of the respiratory, gastrointestinal and urinary tracts, as well as sexually transmitted diseases and chronic osteomyelitis [63].

INH is only active against growing tubercle bacilli, and is not active against non-replicating bacilli or under anaerobic conditions. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads.

The cyclic polypeptide CAP is structurally unrelated to the aminoglycosides and thus is a potential candidate to replace AMK or KAN if resistance to either of them is suspected [81, 82]. prevention networking group, Anti-Infective Drugs Advisory Committee Meeting Clinical Trial Designs for Community Acquired Pneumonia - . • Some case series have successfully used daily half dosing (600 mg once daily) to decrease toxicity and maintain efficacy, however neuropathic reactions seem to be related to duration of therapy rather than dose. Mycobacterium bovis.

The UPCH field and laboratory research team (Universidad Peruana Cayetano Heredia, Lima, Peru; P. Navarro, V. Huancaré, S. Lopez, R. Limascca, F. Garcia and C. Solis), Peruvian National Mycobacteria Laboratory team in Lima (L. Asencios, E. Leo and J. Ramírez) and Unidad Tecnica de TB-MDR (Ministerio de Salud, Lima) staff (R. Jamanca, A. Crossa and A.M. Chavez), who assisted in the significant logistical support required in order to ensure smooth running of the study. Hung NV, Ando H, Thuy TT, Kuwahara T, Hang NT, Sakurada S, Thuong PH, Lien LT, Keicho N. BMC Res Notes. PZase is encoded in M. tuberculosis by the gene pncA [27]. ⇒ www.WritePaper.info ⇐ is a good website if you’re looking to get your essay written for you. In contrast to many other antibiotics used to treat bacterial infections, the FQs have excellent in vitro and in vivo activity against M. tuberculosis [64, 65]. There is also pretomanid which is a new second line drug recommended in 2019 for the treatment of drug resistant TB. Rifampicin acts by binding to the β-subunit of RNA polymerase (rpoB) [17], the enzyme responsible for transcription and expression of mycobacterial genes, resulting in inhibition of the bacterial transcription activity and thereby killing the organism. ●●● https://dwz1.cc/EWG1lhe4, Clinical features,diagnosis and treatment of tuberculosis, Austin Tuberculosis: Research & Treatment, Revised national tuberculosis control programme. By-AMIT ANAND A less common involvement is codon 88 [76]. RIF produces relatively few adverse reactions. what about, General Pharmacology - .  |  Almost all of the antibiotics that can be used to treat TB work when the bacteria are actively dividing. jan bazner-chandler msn, cns, rn, cpnp. We wish to thank all study volunteers, without whose participation this work would have been impossible. I just wanted to share a list of sites that helped me a lot during my studies: .................................................................................................................................... www.EssayWrite.best - Write an essay .................................................................................................................................... www.LitReview.xyz - Summary of books .................................................................................................................................... www.Coursework.best - Online coursework .................................................................................................................................... www.Dissertations.me - proquest dissertations .................................................................................................................................... www.ReMovie.club - Movies reviews .................................................................................................................................... www.WebSlides.vip - Best powerpoint presentations .................................................................................................................................... www.WritePaper.info - Write a research paper .................................................................................................................................... www.EddyHelp.com - Homework help online .................................................................................................................................... www.MyResumeHelp.net - Professional resume writing service .................................................................................................................................. www.HelpWriting.net - Help with writing any papers ......................................................................................................................................... Save so as not to lose, Is all natural gout relief even an option for you? doi: 10.1371/journal.pone.0231320. Extensively drug-resistant TB (XDR-TB) has been reported by 105 countries in 2014. Mehari K, Asmelash T, Hailekiros H, Wubayehu T, Godefay H, Araya T, Saravanan M. Can J Infect Dis Med Microbiol. This results in the weakening of bacteria’s cell wall, which then kills the bacteria.

lead drugs. The five drug groups. Treatment of Tuberculosis: New Cases - Interim. FQs include ciprofloxacin, ofloxacin, levofloxacin, and moxifloxacin. NLM

Categories of second-line agents are summarized in the table . PAS is still useful as part of a treatment regimen for XDR TB although its benefit is limited and it is extremely toxic. Results: Genetic diversity and drug resistance pattern of Mycobacterium tuberculosis strains isolated from pulmonary tuberculosis patients in the Benishangul Gumuz region and its surroundings, Northwest Ethiopia. • Visual function should be monitored in all patients taking linezolid for extended periods (≥3 months) and in all patients reporting new visual symptoms regardless of length of therapy. Although mutations in katG have been shown to be responsible for INH resistance [10], it is not clear whether the regulation of katG expression plays a role in INH resistance.  |  NIH 2 Robert Koch discovered Mycobacterium tuberculosis in 1885 In 2016 worldwide 10.6 million people became sick with TB and 1.7 million TB-related deaths. Drugs of Addiction - . Although belonging to two different antibiotic families, all exert their activity at the level of protein translation. Alerting symptoms: • Black, tarry stools or severe diarrhea • Unusual bleeding or bruising • Extreme tiredness or weakness • Numbness, tingling, or burning pain in your hands, arms, legs, or feet • Change in visual acuity, vision blurring, or visual field defect • Headache, nausea, or vomiting, High-dose isoniazid (H) Group 5 (at high doses) Dosing • 16 to 18 mg/kg per day, typically 600 mg to 1200 mg per week • Some clinicians give it three times a week instead of daily at the 16 to 18 mg/kg dosing, Imipenem/Cilastin Group 5—Beta-lactam/carbapenem In vitro activity—very limited clinical experience Dosing • Adults: 1000 mg IV every 12 hours • In children, meropenem preferred: 20-40 mg/kg/dose IV every 8 hours up to 2 grams per day (high rates of seizures were seen in children treated with imipenem for TB meningitis Side effects • Diarrhea, nausea, vomiting • Seizure noted in CNS infections.

Extremely Drug Resistant TB (XDR-TB) XDR-TB is defined as TB that has developed resistance to at least rifampicin and isoniazid , as well as to any member of the quinolone family and at least one of the following second-line anti- TB injectable drugs: kanamycin, capreomycin, or amikacin 12. Pyrazinamide (PZA) is an important first-line antituberculosis (anti-TB) drug that is used in short-course chemotherapy and is one of the cornerstone drugs in the treatment of MDR-TB .

Any resistance to INH, RMP, SM, EMB and PZA was respectively 36 (13.8%), 15 (5.8%), 26 (10.0%), 19 (7.3%) and 12 (4.6%).