Anti-infective drugs 2

• 1. Isoniazid (INH)
• 2. Rifampin
• 3. Ethambutol
• 4. Pyrazinamide
• 5. Aminoglycosides
• 6. Capreomycin

Inhibition of mycolic acid synthesis (Cell wall synthesis)

• High Resitance: Deletion in katG gene
• encode catalase enzyme needed for INH bioactivation
• Low resistance: Deletion in INHA gene
• gene encoding acyl carrier protein (Target)

• Hepatitis
• Neuritis
• Hemolysis in G6PD deficiency
• SLE in slow acetylators

• Help prevent numbness and tingling that occur
• secondary to Isoniazid neuritis

inhibits DNA-dependant RNA polymerase

Mutationin polymerase enzyme

• Red-orange discoloration of urine
• sweat, and tears
• Proteinuria
• Flu-like symptoms
• Thrombocytopenia
• Induces p450

Inhibitssynthesis of Arabinogalactan (Component of cell wall)

• Loss of red green acuity
• Retrobulbar neuritis

• Arthralgia due to hyperuricemia
• Hepatotoxicity
• Increase porphyrin synthesis

Inhibit protein synthesis

• Streptomycin: Hearing loss, ataxia, nephrotoxicity
• Amikacin: Nystagmus
• Kanamycin: Electrolyte abnormalities

Hearing loss, ataxia

No cross resistance with aminoglycosides Used as 2nd line for Rx of resistant TB with Aminosalicylic acid and cycloserine

Azithromycin + Rifabutin + Ethambutol

Rifampin

• Rashes, GI effects
• Neutropenia
• Induces p450
• No Hepatotoxicity

• PPD=Purified Protein Derived
• Screen Asymptomatic Population

• > 10mm of induration
• (not erythema)

• > 5mm with HIV +ve
• or Close contact

Chest X-Ray

Rx INH alone for 6 Months

• Sputum Cultures
• if +ve --> Rx 4 drugs
• if -ve --> Rx INH alone for 6 Months

3-4 mm induration for 5 years

• Don't blame it on BCG
• You gotta follow protocol
• Chest X-Ray

4 Drugs X 2 months (INH-Rif-PZA-Ethamb) + 2 Drugs X 4 months (INH-Rif) = 6 months

• Initial therapy stay the same then increase duration
• 4 Drugs X 2 months (INH-Rif-PZA-Ethamb) + 2 Drugs X 7 months (INH-Rif)= 9 Months

• Never answer PPD in a case of TB
• Answer Rx
• 4 Drugs X 2 months + 2 Drugs X 4 months

• Answer Chest X-Ray with lead Apron(2nd Trimester)
• if -ve ->Wait until delivery Then INH alone bc INH is bad to the baby "Teratogenic"
• if +ve -> Sputum Cultures if -ve Rx INH alone, if +ve Rx 4 drugs

Neuritis

• 1. Giardiasis: Giardia Lamblia
• 2.  Amebiasis: Entamoeba Histolytica
• 3. Trichomoniasis: Trichomonas vaginalis
• 4. Leishmaniasis: Leishmania Brasiliensis
• 5. Trypanosomiasis: Trypanosoma cruzi
• 6. Toxoplasmosis: Toxoplasma Gondii
• 7. Pneumocystosis: Pneumocystis carinii
• 8. Malaria

• Most common water born disease
• Back-packer's diarrhea

• 1. Giardiasis: Giardia Lamblia
• 2.  Amebiasis: Entamoeba Histolytica
• 3. Trichomoniasis: Trichomonas vaginalis

Diloxanide

• Metronidazole
• Gotta Rx the partner

Stibogluconate

Nifurtimox

Suramin + Melarsoprol

Pyrimethamine + Sulfadiazine

• Trimethoprin-Sulphamethoxazole
• IV Pentamidine
• Atovaquone

Chloroquine

Chloroquine

Chloroquine + Primaquine

Chloroquine + Primaquine

• Chloroquine +/- Primaquine
• Second line: Pyrimethamine-sulfadoxine, Hydroxychloroquine

• Mefloquine
• Second line: Atovaquone-proquanil, Doxycycline

Quinine +/- Doxycycline

Pruritis, ocular dysfunction, hemolysis (Avoid in psoriasis)

• Syncope,extrasystoles
• Avoid in seizure and cardiac arrhythmias

• Neutropenia, hemolysis
• Avoid in pregnancy, G6PD deficiency.

• Cinchonism, CNS defects, hemolysis
• Avoid in pregnancy

• Mebendazole
• Pyrantel pamoate

Decrease glucose uptake and microtubular structure

Ivermectin

Praziquantel

Increase Ca++ influx

inhibits fumarate reductase

inhibits Na+ permeability

Inhibits acetylcholine leading to muscle paralysis

• Dapsone
• Thalidomide

leprosyand dermatitis herpitiformis

Erythema nodosum leprosum

• X
• Physicians should alert male and female patients in effective methods of birth control
• bc Risk of phocomelia (absent arms and legs)