Antimycobacterial Drugs

Abstract

The Mycobacterium tuberculosis complex (MTBC)—including, the M. tuberculosis and seven other closely-related species (like M. bovis)—are the causative bacteria for tuberculosis. Globally, tuberculosis is the most prevalent communicable infectious disease and also remains as the most common cause of infection-related death. Tuberculosis commonly affects the lungs (Pulmonary TB, PTB) and also the other extrapulmonary organs (extrapulmonary tuberculosis, EPTB). The disease manifestations can range from latent TB infection (LTBI), primary TB, secondary (post-primary, reactivation or adult-type) TB to more active progressive primary TB. Sputum microscopy (conventional light microscopy or LED fluorescence microscopy), culture (solid or liquid medium), and molecular methods (Xpert^® MTB/RIF assay, Line Probe Assay) are commonly used diagnostics for the detection of MTBC and assessing drug sensitivity. Serological tests (Interferon-Gamma Release Assays, Lateral Flow Urine—Lipoarabinomannan Assay), tuberculin skin test, and chest radiography are additional methods for diagnosis. The chapter includes in-depth discussion on the various first-line antituberculosis drugs—including, isoniazid (H), rifampicin (R), pyrazinamide (Z), ethambutol (E), streptomycin (S), and the second-line antituberculosis drugs—including, ethionamide (Eto), cycloserine (Cs), para-aminosalicylic acid (PAS), rifabutin, fluoroquinolones, linezolid (Lzd), capreomycin (Cm), bedaquiline (Bdq), delamanid (Dlm) and pretomanid. The treatment guidelines of TB—including the treatment of different drug-resistant TB variants, EPTB, TB in HIV-positive individuals, TB in pregnant or lactating women, TB in children, and LTBI are explained. The pharmacotherapy of leprosy and nontuberculous mycobacteria (NTM) is also outlined.