The Antimycobacterial Drugs

Abstract

Of the ten available antituberculosis drugs, none can stand alone as the treatment of choice. All proven regimens for treatment of active disease are combinations of two or more agents. None of the ten agents are free from dose-dependent side effects, idiosyncratic reactions, being a participant in a drug-drug interaction, or having their predicted action influenced by another pathologic or unusual physiologic condition in the patient. In this article, we will endeavor to identify certain pharmacologic, physiologic, pathologic, and pharmacokinetic factors that may help to maximize the effectiveness of the drugs, while minimizing the risks involved in their use. The antituberculosis drugs, their usual dosage, and their route of administration are shown in Table 1. In the past, these drugs were often considered to be first-line or second-line drugs. First-line drugs are those with greater efficacy and lesser toxicity than those considered to be second line. The second-line drugs are indicated in Table 1 by an asterisk. Today the most effective drugs in the treatment of tuberculosis are isoniazid (INH), rifampin (RM), pyrazinamide (PZA), and streptomycin (SM). Here-