Tuberculosis is one of the main causes of death and disease worldwide, with approximately 1.5 million deaths each year, according to Edward Nardell, M.D., Associate Professor at Harvard Medical School in “The Merck Manual for Healthcare Professionals.” People with this disease may have weight loss, night sweats, fever, cough and even spit up blood. There are several treatments available.
First-Line Treatment
Isoniazid is short for isonicotinic acid hydrazide, or INH. It is an antibiotic and is given along with rifampin, ethambutol and pyrazinamide as the first-line treatment for tuberculosis. All four of these medications are called antibiotics because they kill Mycobacterium tuberculosis, the bacterium that causes the disease. Gopa Green, M.D. of the Department of Medicine at Washington University School of Medicine, explains the first-line treatment in “The Washington Manual of Medical Therapeutics:" Adults take 5 mg of INH for every kilogram of their weight every day, but no more than 300 mg every day. The dosage of rifampin is 10 mg for each kilogram of weight, with a maximum of 600 mg every day. Ethambutol is 15 mg per kilogram of weight every day. Pyrazinamide is 15 to 30 mg for each kilogram of weight every day. The four antibiotics are taken daily for eight weeks. Meanwhile, the lab checks to make sure that INH and rifampin alone can kill M. tuberculosis. If they can, people take INH and rifampin for 16 additional weeks and do not have to take ethambutol and pyrazinamide any longer.
Pyridoxine
Pyridoxine is vitamin B6. Larry Johnson, M.D., Ph.D. at the Central Arkansas Veterans Healthcare System writes in “The Merck Manual for Healthcare Professionals” that this vitamin is used in many of the reactions of the brain and nervous system. But INH drains the body of its vitamin B6 supply. This can lead to seizures. Pyridoxine is a medication that is given because of INH, although young adults who are normally healthy, and children may not need this added to their treatment. People who do take pyridoxine have 25 to 50 mg every day.
Second-Line Treatment
Dr. Petri writes in “Goodman & Gilman's The Pharmacological Basis of Therapeutics” that physicians prescribe streptomycin when people have the form of tuberculosis called disseminated, because it has spread throughout the body. They also prescribe it when people have meningitis because tuberculosis has spread to the meninges membrane that covers the brain. Streptomycin is called a second-line treatment because the first-line antibiotics cannot treat the disseminated form of tuberculosis. The daily dosage of streptomycin is 15 mg for every kilogram of weight, with a maximum of 1.5 grams each day. There are other medications available for people who cannot take streptomycin, because they are pregnant or resistant to it.
References
- “Goodman & Gilman's The Pharmacological Basis of Therapeutics”; Laurence Brunton, Ph.D.; 2006
- The Merck Manual for Healthcare Professionals: Tuberculosis (TB)
- The Merck Manual for Healthcare Professionals: Vitamin B6
- “The Washington Manual of Medical Therapeutics”; Gopa Green, M.D., Ian Harris, M.D., Grace Lin, M.D., Kyle Moylan, M.D.; 2004
