重庆医科大学《内科学精品教学》18tuberculosis.pptVIP

补 * * 补 * 补 * * * * 补 * * 补 * 补 * 补 * 补：*Strains resistant to one or more drugs, excluding combined isoniazid and rifampin resistance. ?Fluoroquinolones: levofloxacin or moxifloxacin. ?Injectable drugs: streptomycin, amikacin, kanamycin, or capreomycin. §Oral second-line drugs: ethionamide, cycloserine, or p-aminosalicylic acid. * * 补 * 补 * pyrazimide pyrazinamide are against intracellular organisms. Pyrazimide has been found to be paticularly useful during the first 2 months of treatment. Pyrazimide can cross the blood-brain barrier Side effect:drug hepatitis, hyperuricemia (arthralgia ) ethambutol Ethambutol is only bacteriostatic. Side effect:optic neuritis (monitor vision and field of view) Streptomycin Streptomycin is bactericide against extracellular Side effect: ototoxicity , nephrotoxicity (creatinine urea nitrogen ) Treatment for TB uses antibiotics to kill the bacteria. The three antibiotics most commonly used are rifampicin ,isoniazid and ethambutol .TB requires much longer periods of treatment (around 6 to 12 months) to entirely eliminate mycobacteria from the body. The recommended basic treatment regimen for previously untreated patients with pulmonary tuberculosis consists of an initial (or intensive) phase of isoniazid, rifampin, pyrazinamide, and ethambutol given for 2 months, followed by a 4-month continuation phase of isoniazid and rifampin. The initial phase rapidly reduces the bacterial burden, by killing the actively growing bacteria, while the continuation phase is protracted and intended to eliminate the subpopulation of bacteria that are replicating more slowly. The choice of regimen for the continuation phase depends on 3 factors: 1) the presence or absence of cavitation on the initial chest radiograph 2) the culture status at the completion of the intensive phase of treatment (month 2) 3) the presence or absence of advanced HIV infection. Tuberculosis in pregnancy Isoniazid rifampin ethambutol are considered safe in