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Antimycobacterials are medications used to treat infections caused by the mycobacterium species. These include tuberculosis, caused by Mycobacterium tuberculosis; leprosy, also known as Hansen’s disease, caused by Mycobacterium leprae; and non-tuberculous lung infections caused by Mycobacterium avium complex or MAC, which includes Mycobacterium avium, Mycobacterium chimaera, and Mycobacterium intracellulare.
Antimycobacterial drugs can be divided into two broad categories. We have the first-line antimycobacterials, which are the standard initial therapy; and the second-line antimycobacterials, used when the first-line drugs aren’t suited, like when they have contraindications, they have failed to treat the infection, or with multi-drug resistant tuberculosis.
The first-line antimycobacterials include isoniazid or INH for short, which is administered orally or intramuscularly; as well as streptomycin or SM, which is given intravenously or intramuscularly; rifampin or RIF, which is given orally and intravenously; and rifapentine or RPT, ethambutol or EMB, and pyrazinamide or PZA, all of which are given orally.
On the other hand, the second-line antimycobacterials include bedaquiline, cycloserine, ethionamide, rifabutin, and aminosalicylic acid all of which are administered orally; as well as capreomycin which is administered intravenously or intramuscularly; and amikacin which can be administered intravenously, intramuscularly, or by inhalation. These medications are mainly used for treating active mycobacterial infections, except rifabutin, which is preferred as preventive treatment against Mycobacterium Avium complex in clients with advanced HIV infection, who are severely immunocompromised. Finally, antimycobacterials also include leprostatic medications, such as dapsone, which is administered orally to treat leprosy.
Mycobacterium is a genus of bacteria that includes many species that are pathogenic to humans. It's known to cause tuberculosis, leprosy, and some non-tuberculosis lung infections. Antimycobacterials are a class of antibiotics effective against mycobacterium species. The primary targets of antimycobacterial drugs are the enzymes that mycobacteria use to build their cell walls. Antimycobacterial drugs are typically administered in combination to target different enzymes and minimize bacterial resistance to these antibiotics.
The first-line antimycobacterials for tuberculosis include rifampin, isoniazid, pyrazinamide, and ethambutol. Second-line antimycobacterials include bedaquiline, cycloserine, ethionamide, rifabutin, aminosalicylic acid, capreomycin, and amikacin. There is also dapsone used to treat leprosy. There may be cases that are multidrug resistant, and these are treated with drugs like bedaquiline, capreomycin, cycloserine, and amikacin.
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