Mycobacterium Infections
Common Infection Sites lung (primary site) brain bone liver
Mycobacterium Infections
Tubercle bacilli are conveyed by droplets. Droplets are expelled by coughing or sneezing, then gain entry into the body by inhalation. Tubercle bacilli then spread to other body organs via blood and lymphatic systems. Tubercle bacilli may become dormant, or walled off by calcified or fibrous tissue.
Anti tubercular Drugs Streptomycin- the first drug used to treat TB Isoniazid (INH)- discovered in 1952, was the 1st oral drug preparation effective against the tubercle bacillus. Pyridoxine ( Vit. B6)- usually given in combination with INH to avoid possible occurrence of Peripheral Neuropathy
Prophylactic Therapy Family Members of a TB patient are usually given prophylactic doses of INH for 6 months to 1 year. Contraindication: Liver Disease ( may cause INH-induced liver damage)
Guide Question?
When a person is diagnosed with TB, the family members are usually given prophylactic dose of what antitubercular drug? a. Streptomycin b. Rifampicin c. Pyrazinamide d. INH
Drug Combinations
( Duration of treatment is reduced from 2 years to 6-9 months) INH + Rifampin INH+Rifampin+ Ethambutol INH+Rifampin+Pyrazinamide (Rifampin & Ethambutol not effective when given alone)
Multidrug Therapy
Effective Divided into 2 phases: Initial Phase ( 2 months) Second Phase ( next 4-7 months) Multidrug Resistance persists: Aminoglycosides (Streptomycin, kanamycin, amikacin) Fluoroquinolones (ciprofloxacin, ofloxacin)
First-Line Drugs- are considered more effective & less toxic than second-line drugs.
Second-line Drugs- maybe used in combination with first-line drugs, especially to treat disseminated TB.
Mechanism of Action Protein wall synthesis inhibitors streptomycin, kanamycin, capreomycin, rifampin, rifabutin Cell wall synthesis inhibitors cycloserine, ethionamide, isoniazid
Side Effects INH peripheral neuritis, hepatotoxicity ethambutol retrobulbar neuritis, blindness rifampin hepatitis, discoloration of urine, stools
Guide Question
A client who is taking rifampin (Rifadin) as part of the medication regimen for the treatment of tuberculosis calls the clinic nurse and reports that her urine is a red-orange color. The nurse tells the client to: a. Come to the clinic to provide a urine sample b. Stop the medication until further instructions are given by the physician c. Take the medication dose with an antacid to prevent this adverse effect d. Expect a red-orange color in urine, feces, sweat, sputum, and tears as a harmless side effect
Antitubercular Therapy Effectiveness depends upon Type of infection Adequate dosing Sufficient duration of treatment Drug compliance Selection of an effective drug combination
Nursing Implications
Obtain a thorough medical history and assessment. Perform liver function studies in patients who are to receive isoniazid or rifampin (especially in elderly patients or those who use alcohol daily). Assess for contraindications to the various agents, conditions for cautious use, and potential drug interactions.
Emphasize to patients to take care of themselves, including adequate nutrition and rest. Patients should not consume alcohol while on these medications nor take other medications, including OTC, unless they check with their physician. Diabetic patients taking INH should monitor their blood glucose levels because hyperglycemia may occur.
INH and rifampin cause oral contraceptives to become ineffective; another form of birth control will be needed. Patients who are taking rifampin should be told that their urine, stool, saliva, sputum, sweat, or tears may become reddish-orange; even contact lenses may be stained. Vitamin B6 may is needed to combat peripheral neuritis associated with INH therapy.
Guide Questions
A client has been taken isoniazid (INH) for a month and a half. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing. a. Small blood vessel spasm b. Impaired peripheral circulation c. Hypercalcemia d. Peripheral neuritis