Drugs for TB, leprosy, and mycobacterium Avium complex infection + Antiprotozoal

Isoniazid (INH)

primary med for treatment and prophylaxis of TB

inhibits mycolic acid

• bactericidal for actively dividing bacteria 

• bacteriostatic for dormant bacteria 

liver injury/hepatotoxicity - multilobular necrosis 

neuropathy & pyridoxine deficiency (B6)

optic neuritis and visual disturbances 

• DO NOT take with antacids 

• monitor for liver injury and watch CMP 

• educate on peripheral neuropathy - may be reversible with B6 vitamins 

Report visual changes immediately 

Rifampin (Rifandin)

Rifamycin class abx, primary agent for treatment and prophylaxis of TB

Inhibits DNA-dependent RNA polymerase 

DOC for TB in combo 

• leprosy - 1x a month 

• MAC - 1x a month 

AE 

• hepatotoxicity 

• hematologic disorders 

• body fluids orange-brown discoloration 

• increased metabolism of oral contraceptives, warfarin, PT, and NNRTI

monitor for hepatitis, liver enzymes, and CBC 

educate on discoloration of fluids 

child-bearing age females need additional birth control 

Pyrazinamide

First line agent used for in combo therapy for TB

converts to pyrazinoic acid to lower pH

inhibits m. tuberculosis

• hepatotoxicity

• hyperuricemia → gouty arthritis

watch for hepatitis, liver enzymes, and serum uric acid levels

report gout-like s/s - use NSAIDS prn

Ethambutol (Myambutol)

first line agent in combo therapy for TB

• GI disturbances

• optic neuritis (blurry vision, restricted visual field, disturbances with color discrimination)

• possible hepatotoxicity

monitor for hepatitis and liver enzymes

take with food to avoid GI upset

report acute visual changes

Chloroquine (Aralen)​ - antiprotozoal

prevents conversion of heme into nontoxic metabolites

concentrates heme in parasitized erythrocytes to produce lethal effect

• DOC for mild to moderate infection cause by p. vivax and p. falciparum

• prophylaxis of infection in erythrocytes

GI effects

visual disturbances

pruritus - itchy skin

• report infection

• monitor in patients with hepatic disease

• minimize GI effects by taking with meals

• NOT able to prevent primary infection of the liver

Artesunate

parenteral antimalarial agent for severe p. falciparum 

produces reactive oxygen species 

damages parasite proteins and membranes 

rapid clearance of parasitized erythrocytes 

• delayed hemolytic anemia (1-3 weeks) 

• elevated liver enzymes 

• rare: bradycardia, hypotension and hypersensitivity 

reconstitute, slow IV push/infusion, notify CDC upon use 

dosing over 3-4 times (0,12,24,48) 

based on weight 2.4 mg/kg/dose 

• monitor CBC for signs of hemolysis