Anti-infective Agents  Antitubercular

 Antifungals
Anti-infective
 Is a general term for any medication that is
effective against pathogens.
 Although antibiotic is more frequently used, this
term refers only to natural substances produced by
microorganism that can kill another microorganism
Bactericidal/bactericidal
 Medications that accomplish this goal by killing the
bacteria
Bacteriostatic
 This drug will not kill the bacteria but instead slow
their growth, depending on the body's natural
defense to dispose microorganism
 Growth slowing drugs
 Antivirals
 Antiprotozoal
 Anthelminthics
Antitubercular drugs
Tuberculosis
 Is caused by the acid-fast bacillus Mycobacterium
tuberculosis or tubercle bacillus.
 One of the world’s major health problems, killing
one person than any other infectious disease,
including acquired immunodeficiency syndrome
(AIDS)-immune dis order characterized by
opportunistic diseases
Tubercles- slow growing mycobacterium usually
become dormant, existing inside cavities

Mutation or errors in genetic code Antitubercular drugs

 Microorganism have the ability to replicate  Agents that treat tuberculosis

extremely rapidly.
 Occur spontaneously and randomly throughout the Streptomycin
bacterial chromosomes.  The first drug used to treat TB, ands given
Acquired resistance parenteral antibiotic

 Clients develops an infection that is resistant to Isoniazid (INH)

conventional drug therapy.  Was the first oral drug preparation effective
Broad spectrum antibiotic against the tubercle bacillus and was
discovered in 1952.
 are effective against many different species of  A bactericidal drug that inhibits tubercle cell
pathogens wall synthesis and blocks pyridoxine (Vit.B6),
which is used for intracellular enzyme
Narrow spectrum antibiotic production.
 Effective against only one or a restricted group of Note: Drug therapy of TB differs from that of most other
microorganisms infections. Mycobacteria have a cell wall that is resistant to
Culture and sensitivity test penetration by antibiotic.

 Process of growing the pathogen and identifying
the most effective antibiotic
Superinfection
 Appearance of secondary infection
 Occur when microorganisms normally present in
the body are destroyed
o 6 to 12 months medications to reach the isolated
microorganism in the tubercles.
o 24 months is needed when the clients develop
multidrug resistant
o 6 to 24 months-different combinations of drugs
may be used. At least 2 and sometimes 4 or more
antibiotics is administered Concurrently

Host flora 2 Broad Categories of Antitubercular Drugs

 Normal microorganism, inhabit the skin, upper 1. First line drugs

respiratory, genitourinary and intestinal tract  Are safer and generally the most effective
o Ethambutol (Myambutol)
Note: The primary goal of antibiotic therapy is to kill o Isoniazid (INH) Pyrazinamide (PZA)
enough bacteria, of to slow the growth of the infection, o Rifampin (Rifadin, Rimactane)
so that natural body defenses can overcome the o Rifapentine (Priftin)
invading agent. o Rifater: combination of PZA with INH and
rifampin.
o Streptomycin
ANTITUBERCULAR AGENT
(adverse effect on book p. 507)
Anti-infective Agent
2. Second line drugs
 More toxic and less effective than the first line
drugs
 Used when resistance develops.
o Amikacin (Amikin)
o Capreomycin (Capastat Sulfate)
o Ciprofloxacin (Cipro)
o Cycloserine (Seromycin)
o Ethionamide (Trecator-SC)
o Kanamycin (Kantrex)
o Ofloxacin (Floxin)
Combination of INH and PZA
 Is approved for tuberculosis prophylaxis ih HIV
positive patients for a short-term therapy of 2
months.
Rifampin and PZA
 Recommended to HIV positive patient with
positive TB skin test as prophylactic for 2 months
Isoniazid
 The primary antitubercular drug used and may
cause isoniazid-induced liver damage
 Must be taken with Pyridoxine (Vit B6) to avoid
deficiency and peripheral neuropathy.
2 Types of Mycobacteria Infects Humans
1. Mycobacterium Leprae
 Responsible for leprosy
 Treated with multiple drugs, usually
beginning with rifampin
2. Mycobacterium Avium Complex (MAC)
 Causes infection of the lungs, most
commonly observed in AIDS.
Macrolides Azithromycin (Zithromax) and
Clarithromycin (Biaxin)
 Effective drugs against MAC
Multi Drugs Therapy
o Isoniazid and Rifampin
o Isoniazid, Rifampin and Ethambutol
o Isoniazid, Rifampin and Pyrazinamide
Pharmacokinetics
 UNH – well absorbed in the GI tract
 Administered IM
 Has low protein binding rate (10%)
 Half-life: 1-4 hours
 Isoniazid is metabolized in the liver and
75% of the drug excreted in the urine
Pharmacodynamic
 Inhibits cell wall synthesis of the tubercle bacillus
 Peripheral neuropathy is an adverse reaction to
isoniazid, so pyridoxine (vitamin B6) is usually
taken to decrease probability of neuropathy
 Should not be taken with alcohol will increase the
incidence of peripheral neuropathy
 Antacids decreases isoniazid absorption
 If phenytoin is taken with isoniazid, the effect of
phenytoin will decrease
Side Effects and Adverse Effects
 Isoniazid – peripheral neuropathy
 INH, Rifampin, Streptomycin – hepatotoxicity
patient may develop headache, blood dyscrasias,
paresthesia, GI distress and ocular toxicity
 Rifampin – turns body fluid orange
 Ethambutol – may develop dizziness, confusion,
hallucination and joint pains
Streptomycin – ototoxicity, optic nerve toxicity,
encephalopathy, angioedema, CNS and respiratory
depression nephrotoxicity and ototoxicity
Nursing Consideration:
1. Assess for the presence of or history of a positive
tuberculin skin test, positive sputum culture, or a
close contact to a person recently infected with TB
2. Assess the patient for a history of alcohol abuse,
AIDS, liver disease, or kidney disease because
many antituberculosis drugs are contraindicated in
those conditions
3. Assess for concomitant use of immunosuppressant
drugs
4. Use caution in clients with renal dysfunction,
pregnancy and lactation
5. Use caution to a client with history of convulsion
disorder
6. Use caution with in clients having chronic liver
disease or alcoholism because of the risk of hepatic
injury due to the production of toxic levels of drugs
metabolites.
7. Ethambutol ((Myambutol) is contraindicated in
clients with optic neuritis
8. Antituberculosis drugs interact with oral
contraceptives and decrease their effectiveness,
female clients with childbearing potential should
use an alternative form of birth control
Client Teaching:
1. Immediately report yellow eye and skin, loss of
appetite, dark urine or unusual tiredness
2. Take supplemental vitamin B^ as ordered to reduce
risk of adverse effects
3. If taking isoniazid, avoid food containing tyramine,
such as age cheese, smoked and pickled fish, beer,
and red wine, bananas and chocolate
4. Wash hands frequently and cover the mouth when
coughing, or sneezing. Properly dispose of soiled
tissues
5. If taking oral contraceptives, use an alternative
form of birth control during antitubercular drug
therapy
6. Complete the full course of treatment