Antituberculosis Drugs

38
Bismillahirrohmaanirrohiim Bismillahirrohmaanirrohiim Asyhadu anlaa ilaaha illalloh Asyhadu anlaa ilaaha illalloh wa asyhadu anna Muhammadan rasuululloh wa asyhadu anna Muhammadan rasuululloh Rodliitu billahi robbaa Rodliitu billahi robbaa wa bil-islaami diinaa wa bil-islaami diinaa wa bi Muhammadin nabiyyaw wa rosuulaa wa bi Muhammadin nabiyyaw wa rosuulaa Robbii zidni ‘ilmaa Robbii zidni ‘ilmaa warzuqnii fahmaa warzuqnii fahmaa Aamiin.... Aamiin.... Do’a belajar

description

ad

Transcript of Antituberculosis Drugs

Page 1: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 1/38

BismillahirrohmaanirrohiimBismillahirrohmaanirrohiim

Asyhadu anlaa ilaaha illallohAsyhadu anlaa ilaaha illalloh

wa asyhadu anna Muhammadan rasuulullohwa asyhadu anna Muhammadan rasuululloh

Rodliitu billahi robbaaRodliitu billahi robbaa

wa bil-islaami diinaawa bil-islaami diinaa

wa bi Muhammadin nabiyyaw wa rosuulaawa bi Muhammadin nabiyyaw wa rosuulaa

Robbii zidni ‘ilmaaRobbii zidni ‘ilmaa

warzuqnii fahmaawarzuqnii fahmaa

Aamiin....Aamiin....

Do’a belajar

Page 2: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 2/38

CURRICULUM VIA!

URRICULUM VIA!

Wiwik Kusumawati,Wiwik Kusumawati, MDMD, M, Master of Health Scienceaster of Health Science

Lecturer of Pharmacology (199 toLecturer of Pharmacology (199 to nownow!!

Lecturer of Me"ical #"ucation ($%%& toLecturer of Me"ical #"ucation ($%%& to nownow!! 'ice Dean for aca"emic affair ($%%& to $%%!'ice Dean for aca"emic affair ($%%& to $%%!

)oor"inator of Pharmacology De*t (199 to $%%$!)oor"inator of Pharmacology De*t (199 to $%%$!

)oor"inator of Me"ical #"ucation +nit ($%%& to)oor"inator of Me"ical #"ucation +nit ($%%& to

$%1%!$%1%!

Page 3: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 3/38

CURRICULUM VIA!

URRICULUM VIA!

PhD )an" of Me"ical #"ucation ofPhD )an" of Me"ical #"ucation of -aculty of-aculty of

Me"icine .a"/ah Ma"a +ni0ersity, ogyakartaMe"icine .a"/ah Ma"a +ni0ersity, ogyakarta

(($%%$%% 2 2 nownow!!

Magister of Health Sciences from -aculty ofMagister of Health Sciences from -aculty ofMe"icine of .a"/ah Ma"a +ni0ersity,Me"icine of .a"/ah Ma"a +ni0ersity,

ogyakarta (199 2 $%%%!ogyakarta (199 2 $%%%!

Me"ical Doctor from -aculty of Me"icine ofMe"ical Doctor from -aculty of Me"icine of

 3irlangga +ni0ersity, Sura4aya (1956 2 1991! 3irlangga +ni0ersity, Sura4aya (1956 2 1991!

.eneral Practitioner (P77 "octor! at #n"e,.eneral Practitioner (P77 "octor! at #n"e,

-lores, 877 (199$-lores, 877 (199$ 2 2 1996!1996!

Page 4: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 4/38

A"IU !RCUL#$I

"IU !RCUL#$I

$ %RU&$ %RU&$

yy

Wiwik KusumawatiWiwik Kusumawati 

Page 5: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 5/38

I"R#%UCI#"

"R#%UCI#"

7u4erculosis :nfection7u4erculosis :nfection

??

Page 6: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 6/38

I"R#%UCI#"

"R#%UCI#"

Pulmonary tu4erculosisPulmonary tu4erculosis

6 to1%$ million new cases of t4c (WH;!6 to1%$ million new cases of t4c (WH;!

$6 to <6 million tu4erculosis "eath$6 to <6 million tu4erculosis "eath De0elo* an" "e0elo*ing countriesDe0elo* an" "e0elo*ing countries

:mmuno"eficiency 0irus (H:'! infection:mmuno"eficiency 0irus (H:'! infection

+* 5% = t4c *> are H:' *ositi0e+* 5% = t4c *> are H:' *ositi0e <6 million, "ual infection<6 million, "ual infection

?eacti0ation 2 "ormant infection?eacti0ation 2 "ormant infection

Page 7: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 7/38

I"R#%UCI#"

"R#%UCI#"

74c infection in :n"onesia@74c infection in :n"onesia@

Po*ulationPo*ulation

Hygiene an" sanitationHygiene an" sanitation

Status of immunityStatus of immunity

Status of economyStatus of economy

Page 8: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 8/38

CA$!

A$!

 3 3 66& years ol" man& years ol" man 4ring to the hos*ital with4ring to the hos*ital with

cough more than < weeks,cough more than < weeks, fe0er,fe0er, an"an"

"ecreasing of a**etite"ecreasing of a**etite after taking history an"after taking history an"

con"ucting clinical e>amination, the "octor "ocon"ucting clinical e>amination, the "octor "ola4oratory test (s*utum test! La4oratory resultla4oratory test (s*utum test! La4oratory result

re0eale" myco4actterium t4c *ositi0e an" there0eale" myco4actterium t4c *ositi0e an" the

"octor *rescri4e antitu4erculosis "rugs"octor *rescri4e antitu4erculosis "rugs

Page 9: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 9/38

'ulmonary

ulmonary

ub(r)ulosis

b(r)ulosis

Prom*t "iagnosis an" effecti0e treatmentProm*t "iagnosis an" effecti0e treatment

.eneral sym*toms.eneral sym*toms

Weight loss, malaise, fe0ersWeight loss, malaise, fe0ers

?es*iratory sym*toms?es*iratory sym*toms

)ough, s*utum an" haemo*tysis)ough, s*utum an" haemo*tysis

Page 10: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 10/38

R(sistan)( of M.

(sistan)( of M.

tub(r)ulosisub(r)ulosis

S*ontaneous mutationS*ontaneous mutation

:m*ro*erly *rescri4e" thera*y:m*ro*erly *rescri4e" thera*y

#rratic "rug ingestion#rratic "rug ingestion

:na"eAuate "osage:na"eAuate "osage

:ncom*lete thera*y:ncom*lete thera*y

Lack of com*liance 4y *>Lack of com*liance 4y *>

Page 11: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 11/38

R(sistan)( of M.

(sistan)( of M.

tub(r)ulosisub(r)ulosis

MD? B :8H an" ?ifam*icinMD? B :8H an" ?ifam*icin

CD? B -luoroAuinolone 1 in/ectionCD? B -luoroAuinolone 1 in/ection

"rug"rug PrimaryPrimary

Secon"arySecon"ary

Page 12: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 12/38

%istribution of 'rimary

istribution of 'rimary

M%R

%R

Page 13: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 13/38

%istribution of

istribution of

$()ondary M%R()ondary M%R

Page 14: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 14/38

Page 15: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 15/38

MA*#R 'R# L!M+

A*#R 'R# L!M+

Compliance ?Compliance ?

Page 16: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 16/38

%#,$

#,$

D:?#)7L ;S#?'# 7H#?3PD:?#)7L ;S#?'# 7H#?3P

-i0e com*onent of D;7S-i0e com*onent of D;7S

Page 17: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 17/38

)L3SS)L3SS ?;+7#?;+7# M3E;? :8D:)37:;8M3E;? :8D:)37:;8

:soniaFi":soniaFi" P;P; PrimaryPrimary

?ifam*in?ifam*in :', P;:', P; PrimaryPrimaryStre*tomycinStre*tomycin :M:M PrimaryPrimary

#tham4utol#tham4utol P;P; PrimaryPrimary

PyraFinami"ePyraFinami"e P;P; Primary )8S orPrimary )8S or

secon"arysecon"ary

)a*reomycin)a*reomycin :M:M Secon"ary or aty*icalSecon"ary or aty*ical

KanamycinKanamycin :M:M Secon"arySecon"ary

)ycloserine)ycloserine P;P; Secon"arySecon"ary#thionami"e#thionami"e P;P; Secon"ary or aty*icalSecon"ary or aty*ical

 3minosalicylic aci" 3minosalicylic aci" P;P; Secon"arySecon"ary

)lofaFimine)lofaFimine P;P;  3ty*ical in H:' *> 3ty*ical in H:' *>

?ifa4utin?ifa4utin P;P;  3ty*ical in H:' *> 3ty*ical in H:' *>

Page 18: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 18/38

%RU&$

RU&$

:8H G ?ifam*in:8H G ?ifam*in 7u4erculoci"al for 4oth e>tracellular intracellular7u4erculoci"al for 4oth e>tracellular intracellular

organismorganism

Stre*tomycinStre*tomycin 7u4erculoci"al for e>tracellular organism only7u4erculoci"al for e>tracellular organism only

PyraFinami"ePyraFinami"e 7u4erculoci"al for intracellular organism7u4erculoci"al for intracellular organism

#tham4utol, *aminosalicylic aci" G#tham4utol, *aminosalicylic aci" Gethionami"eethionami"e 7u4erculostatic7u4erculostatic

Page 19: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 19/38

%RU&$ -I"/

RU&$ -I"/

acterici"al 2 cell wall synthesisacterici"al 2 cell wall synthesis

)om4ination)om4ination

 3cti0e infection 3cti0e infection Secon"ary chemo*ro*hyla>isSecon"ary chemo*ro*hyla>is shoul" 4e gi0en with $shoul" 4e gi0en with $

or more effecti0e "rugsor more effecti0e "rugs

Shoul" ne0er 4e use" as a single to treat acti0eShoul" ne0er 4e use" as a single to treat acti0e

t4ct4c Single agent (monothera*y!Single agent (monothera*y!

Primary chemo*ro*hyla>isPrimary chemo*ro*hyla>is 

Page 20: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 20/38

%RU&$ -I"/

RU&$ -I"/

P;B well an" ra*i"ly a4sor4e"P;B well an" ra*i"ly a4sor4e"

Peak concentration 1 to $ hoursPeak concentration 1 to $ hours

7he "istri4ution is e>tensi0e7he "istri4ution is e>tensi0e

< to 6 mgIkgI"ay 2 $% mgIkgI"ay< to 6 mgIkgI"ay 2 $% mgIkgI"ay Meta4olism 4y acetylation an" hy"ro>ylationMeta4olism 4y acetylation an" hy"ro>ylation

Slow acetylators (Scan"ina0ia, 8orth 3frica! 2Slow acetylators (Scan"ina0ia, 8orth 3frica! 2a"0erse effectsa"0erse effects

?a*i" acetylators (Ea*an, #scimo! 2?a*i" acetylators (Ea*an, #scimo! 2 intermittentintermittentregimenregimen

8o influence 4oth the effect of thera*y an" si"e8o influence 4oth the effect of thera*y an" si"eeffect if :8H gi0en e0ery"ayeffect if :8H gi0en e0ery"ay

Page 21: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 21/38

%RU&$ -I"/

RU&$ -I"/

Si"e effectSi"e effect

Peri*heral neuro*athy 2 1% mgI"ay ofPeri*heral neuro*athy 2 1% mgI"ay of

*yri"o>ine*yri"o>ine :n"uce" he*atic in/ury:n"uce" he*atic in/ury

Page 22: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 22/38

%RU&$ -Rifam0i)in(/

RU&$ -Rifam0i)in(/

 3 firstline 4acterici"al antitu4erculosis 3 firstline 4acterici"al antitu4erculosis

:nhi4its ?83*olymerase:nhi4its ?83*olymerase

)om4ination with *yraFinami"e B J*ersisters)om4ination with *yraFinami"e B J*ersisters

P;, :'P;, :'

P; B well an" com*letely a4sor4tion (em*tyP; B well an" com*letely a4sor4tion (em*ty

stomach!stomach! Peak concentration $ to & hoursPeak concentration $ to & hours

)om4ination with :8H not influence a4sor4tion)om4ination with :8H not influence a4sor4tion

Page 23: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 23/38

%RU&$ -Rifam0i)in(/

RU&$ -Rifam0i)in(/

Distri4ution is e>tensi0e, *roteinDistri4ution is e>tensi0e, *rotein

(al4umin! 4in"ing 5%=(al4umin! 4in"ing 5%=

?e"4rown colouration of 4o"y flui"?e"4rown colouration of 4o"y flui" Meta4olism "eacetylation 2 acti0eMeta4olism "eacetylation 2 acti0e

meta4olitemeta4olite

#>cretion B 4iliary an" renal (<%=!#>cretion B 4iliary an" renal (<%=!

?esistant rifam*icine 2 rifa4utine?esistant rifam*icine 2 rifa4utine

Page 24: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 24/38

%RU&$ -Rifam0i)in(/

RU&$ -Rifam0i)in(/

Dose &6% 2 %% mgI"ay (a"ult! 1% 2 $% mgIkgDose &6% 2 %% mgI"ay (a"ult! 1% 2 $% mgIkg

WI"ay (chil"ren!WI"ay (chil"ren!

Si"e effectSi"e effect ?ash, fe0er, nausea, 0omiting?ash, fe0er, nausea, 0omiting

-lu like syn"rome-lu like syn"rome

He*atoto>ic 2 he*atitisHe*atoto>ic 2 he*atitis

Page 25: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 25/38

%RU&$ -Rifam0i)in(/

RU&$ -Rifam0i)in(/

#nFyme he*atic in"ucer (increase meta4olism#nFyme he*atic in"ucer (increase meta4olism

of oral contrace*tion, corticosteroi",of oral contrace*tion, corticosteroi",

hy*oglycemic agent, 0itamine D!hy*oglycemic agent, 0itamine D!

P3S inhi4its a4sor4tion of rifam*icineP3S inhi4its a4sor4tion of rifam*icine

?ifam*icine :8H (slow acetlators!?ifam*icine :8H (slow acetlators!

Page 26: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 26/38

%RU&$ -'yrazinamid(/

RU&$ -'yrazinamid(/

acterici"al to myco4acteria multi*lyingacterici"al to myco4acteria multi*lyingintracellularly at low *H le0elintracellularly at low *H le0el

7he first $ months of a treatment regimen7he first $ months of a treatment regimen

?e"uce later rela*s rates?e"uce later rela*s rates

 3 shorter "uration of thera*y 3 shorter "uration of thera*y

P; B well a4sor4e"P; B well a4sor4e"

Penetrates well in )S-Penetrates well in )S- 8ausea, flushing, arthralgia,8ausea, flushing, arthralgia, he*atoto>iche*atoto>ic

reactionsreactions

Page 27: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 27/38

$R!'#M1CI"

R!'#M1CI"

 3n aminoglycosi"e 3n aminoglycosi"e

#>tracellular 4acteria#>tracellular 4acteria

Single "rug 2 no effecti0eSingle "rug 2 no effecti0e Must 4e gi0en 4y in/ection (:M!Must 4e gi0en 4y in/ection (:M!

Wi"ely "istri4utions 2 "oesnt cross wellWi"ely "istri4utions 2 "oesnt cross well

into )S-into )S- <% = *rotein 4in"ing<% = *rotein 4in"ing

9% = "rugs e>crete" 0ia urine9% = "rugs e>crete" 0ia urine

Page 28: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 28/38

$R!'#M1CI"

R!'#M1CI"

DoseDose

$% mgIkg W 2 ma>imally 1 gramI"ay$% mgIkg W 2 ma>imally 1 gramI"ay

Si"e effectSi"e effect 8euroto>ic an" ne*hroto>ic8euroto>ic an" ne*hroto>ic

 5 cranial ner0e "amage, 0esti4ular5 cranial ner0e "amage, 0esti4ular

to>icity, rashto>icity, rash )aution)aution

Pregnancy, el"erly, renal "isease, etcPregnancy, el"erly, renal "isease, etc

Page 29: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 29/38

!AM U#L

AM U#L

 3n essentially 4acteriostatic 3n essentially 4acteriostatic

:nhi4its myco4acterial cell wall synthesis:nhi4its myco4acterial cell wall synthesis

P; B well a4sor4e" (6= to 5% =!P; B well a4sor4e" (6= to 5% =!

Doesnt cross Doesnt cross

#>cretion B unchange" in the urine#>cretion B unchange" in the urine

Page 30: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 30/38

!AM U#L

AM U#L

Dose 16 mgIkg WI"ayDose 16 mgIkg WI"ay

Si"e effectSi"e effect

?etro4ul4ar neuritis (4ilateral!?etro4ul4ar neuritis (4ilateral!

?ash, fe0er, :ncreasing 4loo" uric aci",?ash, fe0er, :ncreasing 4loo" uric aci",

etcetc

Page 31: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 31/38

I"IIAL R!AM!"

"IIAL R!AM!"

 3t least < "rugs 3t least < "rugs

:8H, ?ifam*icin, PyraFinami"e:8H, ?ifam*icin, PyraFinami"e

-or at least 5 weeks 2 sensiti0ity-or at least 5 weeks 2 sensiti0ity

esta4lishe"esta4lishe"

Page 32: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 32/38

C#"I"UAI#"

#"I"UAI#"

R!AM!"

R!AM!"

?ifam*icin an" :8H?ifam*icin an" :8H

-urther & months-urther & months

$H?NI&H? 2 months$H?NI&H? 2 months

$#H?IH? 2 9 month$#H?IH? 2 9 month

?ifam*icin not inclu"e" B 15 months?ifam*icin not inclu"e" B 15 months

Page 33: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 33/38

M#"I#RI"&

#"I#RI"&

Monitoring a"0erse effect an" efficacy ofMonitoring a"0erse effect an" efficacy of

"rugs"rugs

Monitoring u* to 1 year after a regimenMonitoring u* to 1 year after a regimencom*letelycom*letely

Page 34: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 34/38

CA$!

A$!

 3 3 &&& years ol"& years ol" woman suffering from t4cwoman suffering from t4c

infection an" also 3 ty*e of he*atitis infectioninfection an" also 3 ty*e of he*atitis infection

Health care *ro0i"er gi0e this *atientHealth care *ro0i"er gi0e this *atient

rifam*icine, :8H, *yraFinami"e asrifam*icine, :8H, *yraFinami"e asantitu4erculosis "rugs for $ months in intensi0eantitu4erculosis "rugs for $ months in intensi0e

*hase*hase

Page 35: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 35/38

$'!CI2IC C#"%II#"

'!CI2IC C#"%II#"

7reatment "uring *regnancy7reatment "uring *regnancy :8H, #tham4utol, ?ifam*icin (safely!:8H, #tham4utol, ?ifam*icin (safely!

:8H,:8H, PyrazinamidePyrazinamide, ?ifam*icin (*oorly tolerate"!, ?ifam*icin (*oorly tolerate"!

#thionami"e is contra in"ication#thionami"e is contra in"ication

Stre*tomycin is 4est a0oi"e"Stre*tomycin is 4est a0oi"e"

7reatment in renal "isease7reatment in renal "isease ?ifam*icin (normal "ose!?ifam*icin (normal "ose!

;ther "rugs (re"uce" "ose!;ther "rugs (re"uce" "ose! PyraFinami"e 2 *reci*itate goutPyraFinami"e 2 *reci*itate gout

Stre*tomycin 2 if essentialStre*tomycin 2 if essential

#tham4utol is 4est a0oi"e" in renal failure (.-? 6%#tham4utol is 4est a0oi"e" in renal failure (.-? 6%

mlImin or < LIh!mlImin or < LIh!

Page 36: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 36/38

$'!CI2IC C#"%II#"

'!CI2IC C#"%II#"

7reatment in li0er "isease7reatment in li0er "isease

:8H, rifam*icin, ethionami"e an" *yraFinami"e can:8H, rifam*icin, ethionami"e an" *yraFinami"e can

all 4e ha*atoto>icall 4e ha*atoto>ic

#tham4utol, Stre*tomycin, :8H#tham4utol, Stre*tomycin, :8H ?egular li0er function monitoring?egular li0er function monitoring

7reatment in chil"ren7reatment in chil"ren

Stan"ar" initial regimenStan"ar" initial regimen

:8H, rifam*icin an" *yraFinami"e:8H, rifam*icin an" *yraFinami"e

if $ "rugs regimenif $ "rugs regimen (:8H an" rifam*icin!(:8H an" rifam*icin! B 9 monthsB 9 months

#tham4utol is 4est a0oi"e"#tham4utol is 4est a0oi"e"

Page 37: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 37/38

R(ff(r(n)(s

(ff(r(n)(s

 30erys Drug 7reatment & 30erys Drug 7reatment &thth e"itione"ition

(7re0or G 8icholas! B 1%& 2 1%6&(7re0or G 8icholas! B 1%& 2 1%6&

)linical Pharmacology, asic Princi*les)linical Pharmacology, asic Princi*lesin 7hera*eutics (Melmon an" Morellis! Bin 7hera*eutics (Melmon an" Morellis! B

11 2 1$11 2 1$

Page 38: Antituberculosis Drugs

7/18/2019 Antituberculosis Drugs

http://slidepdf.com/reader/full/antituberculosis-drugs-56d78dae9dbb5 38/38

$ubhaana3allohumma$ubhaana3allohumma

wabihamdi3awabihamdi3a

asyhadu anlaa illaaha illa antaasyhadu anlaa illaaha illa antaasta4hfiru3a wa atuubu ilai3aasta4hfiru3a wa atuubu ilai3a

Do’a penutup majelis