Treatment Regimens for Leprosy and Other Infections – Antimycobacterial Agents

00:01 The 2017 Centers for Disease Control Guidelines are shown.

00:05 HIV-negative adults with TB are typically treated with isoniazid, rifampin, pyrazinamide, and ethambutol for the first two months.

00:16 And with isoniazid and rifampin for the next four months.

00:20 In the case of HIV positive patients, the regime will also include antiretroviral therapy.

00:27 Please note that there are subtleties in this regime.

00:30 It changes if there are active TB lesions in the lung or elsewhere in the body.

00:35 Most physicians who refer patients to an infectious disease specialist, or respirologist for treatment and monitoring.

00:43 In the case of pregnant women with TB, we will use a combination of isoniazid, rifampin, and ethambutol for the first two months, and isoniazid and rifampin in the next four months.

00:56 We usually will supplement pyridoxine, Vitamin B6 with the regime.

01:02 Again, check the CDC website for subtle changes in treatment regimes for breastfeeding women, for pregnant and breastfeeding women with HIV or with active lesions and other conditions.

01:14 For your USMLE exams, you should be familiar with the three regimes listed.

01:20 You will not need to know the regimes of other countries.

01:23 Let's look at the treatment of leprosy.

01:26 So treatment of leprosy is with dapsone.

01:29 It is the most active drug against leprosy.

01:32 The oral agent penetrates very, very well and it inhibits folic acid synthesis.

01:38 We use dapsone in combination with rifampin many, many times.

01:43 The toxicity of this medication includes GI irritation, rash, hemolysis, especially hemolysis and people who have glucose 6 phosphatase deficiency.

01:55 Acedapsone is another version of dapsone.

01:58 It's a depot formulation that lasts for months.

02:01 And we also use this medication in HIV patients to treat certaines pneumocystis infections as well.

02:09 Okay, let's move on to atypical mycobacterium infections.

02:13 Let's start off with MAC.

02:15 It's also called Mycobacterium avium complex or MAC.

02:20 It's also called Lady Windermere syndrome.

02:23 It seen an HIV-positive patients often.

02:26 It's often involving the right lobe or the right middle lobe.

02:30 Sometimes you see it in the left lingular lobes.

02:32 Now, prophylaxis with CD4 counts less than 50 is Clarithromycin or azithromycin +/- rifabutin.

02:45 With treatment with patients who have CD4 counts less than 50 we have Clarithromycin or azithro plusethambutol, plus rifabutin.

02:57 Other atypical mycobacteria include Mycobacterium marinum and Mycobacterium ulcerans.

03:03 Obviously, these two are seen in certain demographics.

03:08 Marinum is often seen and we used to call this fish workers disease or fish workers ulcers, and mycobacterium ulcerans is seen in certain diabetic patients with ulcer activity.

03:20 It's often treated with regular antituberculous drugs.

03:25 Now, here's a CT scan of a patient with right middle lobe consolidation secondary to Mycobacterium avium.