Anti-Tuberculosis and Leprosy Medications: A Guide to Safe and Effective Use

Anti-Tuberculosis and Leprosy Medications: A Guide to Safe and Effective Use

Part 1: General Introduction

This article provides information about anti-tuberculosis and leprosy medications, including pharmacokinetics, mechanisms of action, side effects, and effective usage.

Part 2: Pharmacokinetics and Actions of Medications

2.1 Anti-Tuberculosis Medications

• Isoniazid (INH):

• Pharmacokinetics: Rapidly absorbed from the gastrointestinal tract, diffuses into various tissues, metabolized in the liver, and excreted via the kidneys.

• Action: Kills Mycobacterium tuberculosis, used in combination with other drugs to treat all forms of tuberculosis.

• Side Effects: Allergies, neurotoxicity, hematological toxicity, hepatotoxicity.

• Rifampicin:

• Pharmacokinetics: Well absorbed from the gastrointestinal tract, excreted through the liver and kidneys, induces P450.

• Action: Kills bacteria both inside and outside cells, effective against Mycobacterium tuberculosis in all three environments.

• Side Effects: Few side effects, hepatotoxicity, gastrointestinal disturbances, red-orange discoloration of urine, sweat, and saliva.

• Ethambutol:

• Pharmacokinetics: Well absorbed from the gastrointestinal tract, concentrated in tissues rich in Zn2+ and Cu2+, excreted via the kidneys.

• Action: The most potent tuberculosis bacteriostatic drug during the multiplication phase, inhibits the incorporation of mycolic acid into the cell wall of Mycobacterium tuberculosis.

• Side Effects: Gastrointestinal disturbances, headache, optic neuritis.

• Pyrazinamide:

• Pharmacokinetics: Rapidly absorbed from the gastrointestinal tract, rapidly excreted.

• Action: Bacteriostatic, potent in acidic environments, kills Mycobacterium tuberculosis in macrophages and monocytes.

• Side Effects: Abdominal pain, loss of appetite, vomiting, fever, liver damage, increased blood uric acid.

• DAPSON (DDS):

• Pharmacokinetics: Similar to PABA, metabolized in the liver, has an enterohepatic cycle.

• Action: Bacteriostatic, inhibits folic acid synthesis, effective against Mycobacterium leprae, and malaria parasites.

• Side Effects: Hemolysis, methemoglobinemia, allergies, gastrointestinal disturbances, neurotoxicity.

• Clofazimine:

• Pharmacokinetics: Rapidly absorbed from the gastrointestinal tract, accumulates in tissues for a long time, excreted via the kidneys and sweat.

• Action: Inhibits Mycobacterium leprae, inhibits some Mycobacterium species causing skin ulcers, chronic bronchitis, and has anti-inflammatory properties.

• Side Effects: Gastrointestinal disturbances, skin discoloration, stool, urine, eosinophilia.

2.2 Leprosy Medications

• Rifampicin:

• Action: Strongly kills Mycobacterium leprae.

• Note: Not used alone, not used in individuals with impaired liver function.

• DAPSON (DDS):

• Action: Used to treat leprosy in combination with other medications, prevents Pneumocystis carinii pneumonia, and prevents malaria when combined with pyrimethamine.

• Clofazimine:

• Action: Used to treat leprosy in combination with other medications.

Part 3: Principles of Medication Use

3.1 General Principles

• Combination Therapy for Tuberculosis: At least 3 drugs during the attack phase and at least 2 drugs during the maintenance phase.

• Correct Dosage: Adhere to the doctor’s instructions.

• Regular Medication: Take at a specific time of day, away from meals.

• Complete Duration of Therapy: The attack phase lasts 2-3 months, the maintenance phase lasts 4-6 months.

3.2 Principles of Treatment for Drug-Resistant Tuberculosis

• Use at least 3 drugs to which the bacteria are still sensitive, including at least one injectable drug.

• MDR: Use 4 to 6 drugs to treat.

• Treatment duration is at least 18 months.

• Surgery to remove lesions may be necessary to improve treatment efficacy.

3.3 Principles of Tuberculosis Treatment in HIV-Positive Patients

• More susceptible to tuberculosis upon exposure to the bacteria.

• Combine anti-tuberculosis drugs with prophylaxis for other opportunistic infections using cotrimoxazole and ARVs as early as possible.

• Note drug interactions between rifampicin and other medications.

3.4 Principles of Tuberculosis Treatment in Pregnant Women

• Only treat when the disease is moderate to severe.

• Isoniazid, rifampicin, ethambutol, and pyrazinamide: cross the placenta.

• Streptomycin, prothionamide, and para-aminosalicylic acid: cause birth defects, not used during pregnancy.

• Increased risk of liver toxicity during pregnancy and in the first 2-3 months postpartum.

3.5 Principles of Leprosy Treatment

• Combination therapy.

• Take enough medication, at the correct dosage.

• Complete duration of therapy: 6 months to 2 years depending on the extent of infection.

• Closely monitor patients: assess treatment response, detect side effects early.

• Combine with physical therapy and exercise therapy to prevent disability in patients.

Part 4: General Notes

• Self-treating tuberculosis or leprosy is dangerous. Consult a doctor for proper diagnosis and treatment.

• Adhere to the doctor’s instructions regarding dosage, duration, and how to take the medication.

• Monitor health regularly to detect side effects of medication early.

Part 5: Conclusion

Anti-tuberculosis and leprosy medications are essential for treating these infections. Proper medication use, following the doctor’s instructions, is crucial for achieving optimal treatment outcomes and minimizing side effects.