Tuberculosis continued

Tuberculosis continued
First-line drugs
isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB) are used together in initial treatment
INH is given orally once/day, has good tissue penetration (including CSF), and is highly bactericidal. It remains the single most useful and least expensive drug for TB treatment. Decades of uncontrolled use—often as monotherapy—in many countries (especially in East Asia) have greatly increased the percentage of resistant strains which is around 10% of isolates are INH-resistant. INH is safe during pregnancy.
Adverse reactions include:
1- General: rash, fever, and, rarely, anemia and agranulocytosis.
2- Liver disease INH causes asymptomatic, transient aminotransferase elevations & clinical (usually reversible) hepatitis occurs more often in patients> 35 yr, alcoholics, postpartum women, and patients with chronic liver disease.
3- Peripheral neuropathy can result from INH-induced pyridoxine (vitamin B6) deficiency, most likely in pregnant or breastfeeding women, undernourished patients, patients with diabetes mellitus or HIV infection, alcoholics, patients with cancer or uremia, and the elderly. A daily dose of pyridoxine 25 to 50 mg can prevent this complication.