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Treatment Regimens for Mycobacterium Tuberculosis – Antimycobacterial Agents

by Pravin Shukle, MD

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    00:01 Let's take a look at the guidelines in the drugs used to treat mycobacterial infections in TB.

    00:07 Remember that this is not a guideline on a set of treatments for latent TB.

    00:13 Latent TB means that the organism is dormant and dormant organisms don't activate some of the drugs that we just talked about.

    00:20 So, latent TB has its own set of treatment regimens.

    00:25 Make sure you look up latent TB regimens in your own region of the world.

    00:29 They will vary based on where you live.

    00:32 Remember that pregnant and breastfeeding women need some vitamin B such as pyridoxine supplementation and that's because some of these drugs interfere with the vitamin B6 pathway.

    00:46 These are the drugs that I'm going to address right now and these are the three letter designations that I'll use in this particular slide set.

    00:53 Now, in the first two months, patients who have adult TB or adults who have TB but don't have HIV are usually treated in the first two months with isoniazid, rifampin, pyrazinamide and ethambutol.

    01:09 In the following four months, so, a total of six months of treatment, they'll get isoniazid and rifampin.

    01:15 Now, if you have an adult who has TB and HIV, then, you're gonna have ART and INH, possibly, rifampin, pyrazinamide and ethambutol.

    01:27 Now, what is ART? ART is antiretroviral therapy, ART. Isoniazid is INH.

    01:35 So, we have a combination of the antiretroviral therapy and the isoniazid, plus, these three other agents.

    01:41 In the following four months, we're going to have the antiretroviral in combination with isoniazid and rifampin.

    01:49 And finally, mothers who are pregnant with active TB, we'll give them isoniazid, rifampin, and ethambutol.

    01:57 We won't give them PZA. In the final four months for a total of six month therapy, we'll give them INH and RIF.

    02:09 Now, we have different guidelines in different parts of the world.

    02:12 For my American students, here is the website from the Centers for Disease Control.

    02:20 For my countrymen in Canada, this is the website through Health Canada.

    02:25 My friends in the United Kingdom can look at the very excellent Nice guidelines, N-I-C-E.

    02:31 For my friends in India, you can look at this website.

    02:35 For my friends in other parts of Europe and for my friends in Africa, we have all of these different guidelines that are relatively specific for your region of the world.

    02:44 Now, if you go to the CDC website, they will actually give you guidelines for different parts of the world as well but please look up your own region's guidelines so that you can have a really good idea of which ones to learn for your particular part of the world.

    03:00 If you're studying for the USMLE, please look at the CDC guidelines.

    03:04 These guidelines can change every single year and one year, I remember, it actually changed in six months.

    03:11 So, keep up to date with the guidelines.

    03:13 There's no way that I can keep up with the lectures and the guidelines, so, look them up yourself before you go and write your exam.

    03:20 Thank you very much. It was great having you listen to me. Go write your exam.

    03:25 I know you're gonna do well. Good luck.


    About the Lecture

    The lecture Treatment Regimens for Mycobacterium Tuberculosis – Antimycobacterial Agents by Pravin Shukle, MD is from the course Antimicrobial Pharmacology. It contains the following chapters:

    • Drugs Regimens - Mycobacterium Tuberculosis
    • Drugs Regimens - Mycrobacterium Leprae
    • Drugs Regimens - Atypical Mycrobacterium Infections

    Included Quiz Questions

    1. Pyrazinamide
    2. Rifampin
    3. Dapsone
    4. Isoniazid
    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

    Author of lecture Treatment Regimens for Mycobacterium Tuberculosis – Antimycobacterial Agents

     Pravin Shukle, MD

    Pravin Shukle, MD


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