ANTI-TUBERCULAR
PRESENTED BY
SYED FIRASATULLAH
DEFINITION
• Tuberculosis is an infectious disease caused by tubercle bacillus
» Mycobacterium tuberculosis
» Mycobacterium bovis
» Mycobacterium africanum
SYMPTOMS
Weight Loss Coughing for
2 weeks or
longer
Chest
Pain
Coughing up
Blood
Feeling
Night
Fever Tired or
Weak
Sweats
PATHOPHYSIOLOGY
• Bacterial entry
• T Lymphocytes.
• Macrophages.
• Epitheloid cells.
• Proliferation.
• Central Necrosis.
• Giant cell
formation.
• Fibrosis.
DIAGNOSIS
SPUTUM TEST
An acid fast stain (Ziehl-Neelsen or Kinyoun's acid fast
stains) will show the organisms as slender red rods.
An auramine stain of the organisms as viewed under fluorescence
microscopy will be easier to screen and more organisms will be
apparent.
CHEST RADIOGRAPHY
HEAF TEST
MANTOUX TEST
CLASSIFICATION
1ST LINE 2nd LINE
BACTERIOCIDAL BACTERIOCIDAL
1. Isoniazid 1. Capriomycin
2. Rifampicin 2. Kannamycin
3. Pyrazinamide
4. Streptomycin
BACTERIOSTATIC BACTERIOSTATIC
1. Ethambutol 1. Ethionamide
2. PAS 2. Cycloserine
3. Thiacetazone
ISONIAZID (H)
MECHANISM OF ACTION SIDE EFFECTS
• Isoniazid is an antibacterial agent • Peripheral neuropathy
active only against Mycobacteria. • Hepatitis
It may act by inhibiting formation • Fatigue
of the mycobacterial cell wall.
• Weakness
• It inhibits mycolic acids which
• Malaise
are important constituents of cell
wall • Loss of appetite
• Resistance to Isoniazid alone • Nausea
develops quickly in individual • Vomiting
patients, so it should always be
given in combination with other
anti-tuberculosis agents.
RIFAMPICIN (R)
MECHANISM OF ACTION SIDE EFFECTS
• It inhibits DNA dependant • Orange tinge in body
RNA polymerase and fluids
impairs RNA synthesis. • Hepatitis
• Rifampicin may be • Dizziness, confusion
bacteriostatic or • Renal failure
bacteriocidal depending
• Thrombocytopenia
upon organisms
suceptability and drug
levels at the infection site
PYRAZINAMIDE (Z)
MECHANISM OF ACTION SIDE EFFECTS
• It is active in acidic pH • Hepatotoxicity
and is also effective • Mettalic taste
against organisms in • Raised serum uric acid
macrophages.
levels causing arthritis
• Weakness
• Rashes
• Thrombocytopenia
ETHAMBUTOL (E)
MECHANISM OF ACTION SIDE EFFECTS
• Optic neuritis
• It inhibits or interferes • Renal failure
with mycolic acid which is
responsible for
• Mental
mycobacterial cell wall disturbances
synthesis • Thrombocytpenia
• Anaphylactic
reactions
STREPTOMYCIN (S)
MECHANISM OF ACTION SIDE EFFECTS
• It directly inhibits the 30 s • Ototoxicity
ribosomal subunit, • Neuromuscular blockade
inhibiting bacterial protein • Nephrotoxicity
synthesis
• Leukopenia
• Apnea
• Exfoliative dermatitis
• Anaphylaxis
• Chronic. A patient with TB who is sputum-
positive at the end of a standard retreatment
regimen with essential antituberculosis drugs.
• MDR-TB. A patient who has active tuberculosis
with bacilli resistant at least to both rifampicin
and isoniazid.
