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Updated: Aug 28 2025

Anti-Mycobacterials

  • Introduction
    • Drugs
      • rifamycins
      • isoniazid
      • pyrazinamide 
      • ethambutol
      • dapsone
      • clofazimine
      • streptomycin
    • Clinical use
      • Classic Treatment Paradigm for Mycobacteria
      • Organism
      • Prophylaxis
      • Treatment
      • Mycobacterium tuberculosis
      • Isoniazid
      • Active infection: RIPE therapy
      • Rifampin
      • Isoniazid
      • Pyrazinamide
      • Ethambutol
      • Latent infection:
      • isoniazid x 9 months
      • Mycobacterium avium-intracellulare
      • Azithromycin
      • Rifabutin
      • Azithromycin + ethambutol
      • Can also add rifabutin or ciprofloxacin
      • Mycobacterium leprae
      • Tuberculoid: dapsone + rifampin
      •  Lepromatous: dapsone + rifampin + clofazimine
    • Anti-Mycobacterial Medications
      DrugMechanism of Action
      Adverse Effects
      Notes
      <p>Rifamycins (rifampin and rifabutin)</p><ul><li>Inhibits DNA-dependent RNA polymerase
      </li></ul>
      <ul><li>Hepatotoxicity</li><li>Red or orange body fluids<a title="question" href="#217144" link-extracted="true"><img src="/images/question.png" alt=""></a></li><li>CYP450 inducer</li></ul><ul><li>Rifabutin has less CYP450 effect, thus favored for HIV patients</li><li>Mutations occur due to decreased binding to RNA polymerase</li><li>Resistance occurs rapidly if used as monotherapy</li></ul>
      Isoniazid<ul><li>Inhibits synthesis of mycolic acids
      </li></ul>
      <ul><li>Hepatotoxicity
      </li><li>Inhibits CYP450</li><li>Drug-induced systemic lupus erythematosus
      </li><li>Vitamin B6 deficiency<ul><li>peripheral neuropathy</li><li>sideroblastic anemia
      </li></ul><ul><li>co-administer with pyridoxine (B6) to reduce side effects<a title="question" href="#217124" link-extracted="true"><img src="/images/question.png" alt=""></a></li></ul></li></ul>
      <ul><li>May be used as monotherapy for prophylaxis and latent TB</li><li> Mutations occur due to underexpression of enzyme required to convert drug into active metabolite</li></ul>
      Pyrazinamide
      <ul><li>Unknown but may work through host phagolysosomes
      </li></ul>
      <ul><li>Hepatotoxicity</li><li>Hyperuricemia</li></ul> 
      -
      Ethambutol<ul><li>Inhibits arabinosyltransferase and disrupts cell wall
      </li></ul>
      <ul><li>Optic neuropathy
      <ul><li>red-green color blindness
      </li></ul></li></ul>
      -
      Dapsone
      <ul><li>Inhibits dihydropteroate synthesis (anti-folate)
      </li></ul>
      <ul><li>Methemoglobinemia</li><li>Hemolysis (G6PD deficiency patients)
      </li></ul>
      -
      Clofazimine<ul><li>Disrupts DNA
      </li></ul>
      <ul><li>Gastrointestinal upset</li><li>Dry skin</li><li>Pink/brown skin and body fluid dyspigmentation
      </li></ul>
      -
      Streptomycin<ul><li>Interacts with 30S ribosomal subunit
      </li></ul>
      <ul><li>Tinnitus</li><li>Vertigo</li><li>Ataxia</li><li>Renal toxicity
      </li></ul>
      <ul><li>Second-line treatment forM. tuberculosis</li></ul>
      • Anti-Mycobacterial Medications
      • Drug
      • Mechanism of Action
      • Adverse Effects
      • Notes
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