TB III Flashcards
(30 cards)
What is the new regimen for drug-resistant TB?
BPaL-L:
* At least 3 drugs used for 6 months
What is the long regimen for Drug resistant TB?
18 months
What are the indications for the long TB regimen?
Complicated EPTB / extensive
disease on CXR
* Children < 6 years
nd
* Hxof previous treatment with 2
line drugs for more than 1 month
* Contact with XDR / Pre-XDR
* Both INH mutations
What is the 6 months BPaL-L regimen?
Bedaquiline,
* Pretomanid,
* Linezolid (600 mg)
* With or without levofloxacin (if sensitive)
What are the 5 core drugs for long course TB treatment?
Bedaquiline
Linezolid
Levofloxacin (substitute if flouroquinolone resistance)
Clofazimine
Terizidone
What is a side effect of terizidone? How is it prevented
It causes peripheral neuropathy
Prevented by co-administration with pyridoxine (50mg for adults, 25mg to children)
Long course drug-resistant TB treatment for children >/= 6 years old
Bedaquiline ≥6 years is safe for use
In children between 3-6 years, which drug can be substituted for bedaquiline in the long course TB treatment?
Delamanid
For children under 3 years old, which drug can be used to substitute for bedaquiline?
Para-aminobenzoic acid
MOA of bedaquiline
Inhibits mycobacterial ATP synthase
Metabolism of Bedaquiline?
PKs: metabolised by CYP3A4 need LFT monitoring (ALT, AST, bili)
Bedaquiline interacts with which group of drugs?
CYP3A4 inhibitors / inducers, hepatotoxic drugs
fluoroquinolones, macrolides, clofazimine, diseases
What are the major adverse effects of bedaquiline?
QT prolongation (ECG monitoring – stop if
>500ms)
MOA and distribution of Terizidone
MOA: Inhibits peptidoglycan synthesis
* Widely distributed including CSF
Major adverse effects of Terizidone
Peripheral neuropathy (treat with pyridoxine or amitriptyline)
Seizures, anxiety, depression, psychosis
Drug interaction with Terizidone
Isoniazid
Contra-indications of Terizidone
CI: psychiatric disorders/symptoms
Explain the pharmacokinetics of Clofazimine
Accumulate in tissues: fat, skin, liver, kidneys and reticulo-endothelial cells – cause
red-brown pigmentation of conjunctiva and skin; may impart red colour to urine,
sweat, tears, sputum
Where is clofazimine eliminated?
In bile and faeces
What should you monitor when a patient is taking Clofazimine?
Monitor hepatic function
What should you counsel a patient on when using Clofazimine?
Take with food to diminish GI upset
In children taking Delamanid, what should you monitor?
monitor for neuropsychiatric adverse effects:
insomnia, hallucinations, night terrors
What are common Adverse effects of Delamanid?
Common, nausea, vomiting and dizziness
* QT prolongation (discontinue if QTcF is >500ms or ventricular
arrhythmia)
* DI: fluoroquinolones, macrolides, bedaquiline, clofazimine
