- Disseminate info on TB in India
- Improve care of TB patients in India
- Enable doctors and NGO's interested in TB control to interact
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Objectives
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| Dosage and adverse effects of second-line antituberculous agents | ||||
| Drug | Type of activity | Average daily dose (normal renal function) | Adverse effects | Recommended monitoring |
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| Injectable agents - Capreomycin (Capastat Sulfate) - Amikacin sulfate (Amikin) - Kanamycin sulfate (Kantrex) |
Bactericidal | 15 mg/kg IM (up to 1 g for capreomycin; up to 750 mg for amikacin and kanamycin) | Hearing loss, ataxia, tinnitus, nephrotoxicity, electrolyte changes; contraindicated in pregnancy | Monthly audiometry; weekly or biweekly measurement of serum electrolyte, BUN, creatinine levels |
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| Quinolones | Weakly bactericidal | GI complaints, dizziness, insomnia, headaches; contraindicated in children and pregnancy | ||
| - Ofloxacin (Floxin) | 400-800 mg bid | |||
| - Ciprofloxacin (Cipro) | 750 mg bid | |||
| - Sparfloxacin (Zagam) | 200 mg qd | |||
| - Levofloxacin (Levaquin) | 500-750 mg qd | |||
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| Ethionamide (Trecator-SC) | Bactericidal | 250 mg bid initially, increased to goal of 1 g daily | GI complaints (nausea, vomiting, metallic taste), CNS complaints (peripheral neuropathy, psychosis), hepatitis, hypoglycemia; contraindicated in pregnancy | Use with caution in patients with underlying liver disease, diabetes mellitus, or psychiatric illness; monitor electrolytes and liver-associated enzyme levels monthly |
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| Cycloserine (Seromycin Pulvules) | Bacteriostatic | 250-500 mg PO bid | CNS complaints (dizziness, slurred speech, headache), peripheral neuropathy, psychoses (especially depression, suicide) (more common with underlying psychiatric illness or alcoholism) | Observe closely for mood and personality changes; consider vitamin B6 to minimize side effects |
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| Para-aminosalicylic acid (Paser Granules) | Bacteriostatic | 10-12 g/day in 3-4 divided doses | GI intolerance (often severe), drug-induced lupus, lymphoid hyperplasia, hepatitis, inhibition of iodine uptake and hypersensitivity | Monitor liver- associated enzyme levels monthly; test thyroid function with prolonged administration |
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BUN, serum urea nitrogen; CNS, central nervous system; GI, gastrointestinal. | ||||
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Duration of treatment for MDR TB depends on the response. In general, treatment with at least three effective drugs should be continued until the culture becomes negative, and then a regimen of at least two drugs should be continued for 12 to 24 months (2,7,8). Consultation with an experienced specialist should be considered for management of all cases of MDR TB.
| Introduction | | | Criteria of MDR TB | | | Causes | | | Prevention | | | Management | | | Dosage and side effects |