Anti-TB Antibiotics

Causative agent: Mycobacterium Tuberculosis

First Line TB Drugs

RIPES or RESPIre

MOA  Side effects
Rifampin, Rifapentine, Rifabutin Inhibit DNA-dependent RNA polymerase
-Rifabutin is similar to rifampin, same MOA
-Rifapentine is a long-acting anti-TB drug similar to Rifampin, same MOA
Hepatotoxic (Asymptomatic jaundice, high LFTs)
RED-orange urine, sweat, and tears. Rifampin cause urine, sweat, and tears to become RED-orange in color. This doesn’t harm the patient, but they need to know or they will panic.
INH (Isoniazid) Interferes with the synthesis of mycolic acid components of the cell wall of mycobacterium. Hepatotoxic.
-Can induce pyridoxine (Vit. B6) deficiency causing pellagra (peripheral neuropathy/neuritis, rash, anemia). That’s why you should give Vit B6 to patients taking INH
Pyrazinamide unknown.
Pyrazinamide is an analog of nicotinamide.
Hepatotoxic!
-Gout! Inhibits uric acid secretion > increased levels of uric acid.
Ethambutol unknown -Ocular toxicity (decreased visual acuity, color vision loss, loss of central vision-central scotoma). Ask the patient to read fine newspaper print every day to check for this side effect and to report to you if they develop difficulty so.
Streptomycin (an aminoglycoside) Binds to 30S ribosomal subunit to inhibit protein synthesis. Vestibular & ototoxicity.

 

Second Line TB Drugs

These are used when multiple antibiotics are needed for the treatment of multi-drug resistant TB

  • Para-aminosalicylic acid
  • Capreomycin sulfate
  • Cycloserine
  • Ethionamide
  • Kanamycin (Aminoglycoside)
  • Amikacin (Aminoglycoside)
  • Quinolones such as levofloxacin
  • Linezolid
  • Bedaquiline (Approved in Dec 2012 for tx of MDR-TB)

 

Anti-Leprosy Antibiotics

Causative agent: Mycobacterium Leprae

Severe cases of leprosy disease should be treated with three drugs (rifampin, dapsone, clofazimine) for at least two years and until patients are AFB (acid-fast bacilli) negative. Less severe cases can be treated with two drugs (rifampin and dapsone) for six months.

MOA  Common Uses Side Effects
Dapsone, Sulfoxone (both are sulfones) PABA antagonist, similar MOA as sulfonamides. This results in blocking of dihydrofolate (DHF) synthesis. DHF is a precursor of tetrahydrofolate (TH4) which is necessary for making purines. This leads to inhibition of bacterial DNA synthesis. Mycobacterium leprae. -Skin rash, drug fever.
-Bone marrow suppression; agranulocytosis – low neutrophils
-Leprosy reaction
Rifampin Inhibit DNA-dependent RNA polymerase  Rifampin treats both TB and leprosy. See above.
Clofazimine Binds to DNA. It also has anti-inflammatory actions that are helpful for treating leprosy reactions. Mycobacterium leprae.
It’s anti-inflammatory actions that are helpful for treating leprosy reactions.
-Red and black skin discolorations.

 

Resources:
Clinical microbiology made ridiculously simple.

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