Second Line Drugs for Tuberculosis MCQs

Initial regimen for mycobacterium avium: At least two-antimycobacterial drugs; preferred agents include: Macrolide: clarithromycin (first-line) ORazithromycin AND ethambutol Optional third and fourth drugs [1] Consider in patients with any of the following: A high risk of mortality (e.g., CD4 count Drug resistance High mycobacterialload Inadequate response to ART Agents (any of the following): Rifabutin Fluoroquinolone: levofloxacin or moxifloxacin Injectable agent: amikacin or streptomycin Reference: Harrison's principles of internal medicine - 20 th addition Page no. 1278

Cycloserine is associated with Neuro-Psychiatric Side effect. Adverse effect of 2 nd line Anti-Tubercular Drug: Thioacetazone (tuberculostatic drug): Hepatitis, bone marrow suppression and Steven Johnson syndrome. Para amino salicylic acid (PAS) can cause kidney, liver and thyroid dysfunction. Ethionamide can cause hepatitis, optic neuritis and hypothyroidism. Cycloserine can cause neuropsychiatric adverse effects. Kanamycin, Amikacin and Capreomycin can cause ototoxicity, nephrotoxicity, hypokalemia and hypomagnesemia. Rifabutin commonly causes gastrointestinal adverse effects. Rarely, it can cause anterior uveitis, clostridium difficile-associated diarrhea, diffuse polymyalgia syndrome, yellow skin discoloration (Pseudo-jaundice) and pancytopenia. REFERENCE: Basic & Clinical Pharmacology, 14th Edition By Bertram G. Katzung Page no. 846-849