Treatment Regimens for Leprosy and Other Infections – Antimycobacterial Agents

by Pravin Shukle, MD

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    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.

    About the Lecture

    The lecture Treatment Regimens for Leprosy and Other Infections – Antimycobacterial Agents by Pravin Shukle, MD is from the course Antimicrobial Pharmacology.

    Included Quiz Questions

    1. Folic acid synthesis inhibition
    2. Creates pores in the cell wall
    3. Reverse transcriptase inhibition
    4. Blocks sodium channels
    5. Intercalates DNA
    1. CD4 count < 50
    2. HIV viral load > 100000
    3. In HIV+ patients with comorbid respiratory disorders
    4. On diagnosis of an AIDS-defining illness
    5. On diagnosis of HIV
    1. Rifampin is the most active drug against leprosy.
    2. Dapsone is associated with hemolysis particularly in patients with G6PD.
    3. Acedapsone is a depot formulation of dapsone that lasts for months.
    4. Mycobacterium avium complex is often seen in AIDS patients.
    5. Treatment of Mycobacterium avium complex in a patient whose CD4 count is <50 includes clarithromycin (or azithromycin), ethambutol, and rifabutin.

    Author of lecture Treatment Regimens for Leprosy and Other Infections – Antimycobacterial Agents

     Pravin Shukle, MD

    Pravin Shukle, MD

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    By Jorge Alberto G. on 03. July 2020 for Treatment Regimens for Leprosy and Other Infections – Antimycobacterial Agents

    I can't rate five stars to all the classes due to the time, eventually I will. Thank you Dr. Virtual hugs from Mexico.