Case Studies – Antimycobacterial Agents

by Pravin Shukle, MD

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    Let's move on to a question. A woman from a first nations reserve in western Alaska presents with cough with flecks of blood in her green sputum. She has a three month history of fatigue, weight loss and poor appetite. Her sputum is identified with microbaterium tuberculosis. There has been one historical case from her reserve without resistance patterns. The appropriate course of action would be A. Initiate isoniazid, rifampin, pyrazinamide and streptomycin. B. Initiate rifampin to treat for 9 months. C. Initiate isoniazid for 18 months. D. Initiate isoniazid, rifampin and pyrazinamide. If the organisms are fully susceptible, pyrazinamide can be stopped in two months. Or E. Initiate pyrazinamide for 18 months. Okay you chose D and that's correct. Now this is a hard question but let's just go through it so that you understand the concept. And when you to the exam you'll feel much more confident answering these kinds of questions. So in areas with less than 4% resistance isoniazid, a three drug combination is actually reasonable. Now the questions on TV will not focus on your intimate knowledge of each of it's drugs, but on the uses and indications. If the patient had come from say an area of high endemic resistance, like South Asia or South East Asia, Somalia or China, a 4 drug regimen is appropriate. Now some people are advocating the 2 drug approach with just isoniazid and rifampin for 9 or 18 months. This is not unreasonable and could be correct. But the reality is that we use the 3 drug combination in almost all cases. So if you are caught with a question that gives you this choice and no other, then the 2 drug approach would be the answer. But in most cases you're going to be given an option...

    About the Lecture

    The lecture Case Studies – Antimycobacterial Agents by Pravin Shukle, MD is from the course Antimicrobial Pharmacology.

    Author of lecture Case Studies – Antimycobacterial Agents

     Pravin Shukle, MD

    Pravin Shukle, MD

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