This is an approach to treatment of Pulmonary tuberculosis , with illustration of Drug doses , side effects, recommended course and possible combinations. We are going to discuss the differential diagnosis (DDx) of tuberculosis A. Medical (Drug) treatment of Tuberculosis 1- Bed rest and isolation of patients who are excreting the organism 2- Good nourishment 3- Drugs: Rules 1- Long course to avoid relapse 2- Combinations to avoid resistance (at least two antimicrobial agents) 3- Rifampicin shortens the course of treatment to 9 months. 4- I N H must be used 5- Side effects of drugs must be known. Drugs • I.N.H: the most effective constant drug, it is bactericidal, it interferes with lipid and nucleic acid synthesis. Dose: 200-300 mg/day (5mg/kg) Side effects: hepatotoxicity, polyneuropathy. Pyridoxine 10 mg/d is given to prevent polyneuropathy. INH is acetylated in the liver, so rapid acetylators are more liable to develop hepatitis due to the acetylated ****bolite, however slow acetylators are more liable to develop neuropathy. • Streptomycin (Bactericidal): - Dose: 1gm I.M daily - Main side effects: ototoxicity ( irreversible) • Rifampicin (Bactericidal, it inhibitis DNA dependent RNA polymerase) (10 mg/kg). 450-600 mg/d, it is hepatotoxic, it also causes vasculititis, hypersensitivity nephritis and flu like symptoms. • Ethambutol ((Bacteriostatic inhibiting RNA synthesis) 10-25 mg/kg, it leads to optic neuritis • Pyrazinamid (PZA) (Bactericidal) 20- 30 mg/kg, (It may lead to hepatitis and hyperuricemia) B- Surgical ttt : Read more at : Treatment of Tuberculosis , regimens and differential diagnosis
