Tuberculosis is a disease that affects the lungs, kidneys, spine and brain. It is caused by a bacterium known as Mycobacterium tuberculosis. Tuberculosis can be treated with antibiotics. The Centers for Disease Control and Prevention list 10 antibiotics approved for use against tuberculosis. However, some strains of tuberculosis bacteria are becoming resistant to the standard treatments, meaning those medications will no longer work to treat tuberculosis. There are still antibiotic options available to treat even these resistant strains. Most patients require treatment with three to four antibiotics for drug-resistant tuberculosis.
First-Line Agents
According to the online document Drug-Resistant Tuberculosis: A Survival Guide for Clinicians from the Francis J. Curry National Tuberculosis Center, tuberculosis bacteria can be resistant to one drug or to multiple drugs. Those bacteria resistant to the two most commonly used first-line medications are called multi-drug resistant tuberculosis. These bacteria are resistant to isoniazid and rifampin. In this case, other first-line medications like pyrazinimide and ethambutol are used to start treatment. Additional medications are then added based on the resistance pattern of the bacteria.
Injectable Medications
Streptomycin, capreomycin, kanamycin and amikacin are also listed for use against multi-drug-resistant tuberculosis in Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis. According to the World Health Organization guidelines, streptomycin is usually the first choice, unless the bacteria is also resistant to it. The World Health Organization considers amikacin and kanamycin to be very much alike and are appropriate second choices instead of streptomycin.
Fluoroquinolones
Fluoroquinolone antibitoics are used as third-line agents, according to the World Health Organization. These are medications such as levofloxacin, moxifloxacin, ciprofloxacin, gatifloxacin and ofloxacin. The World Health Guidelines recommends using moxifloxacin or gatifloxacin due to their increased potency, however, this would also depend on the specific bacterial strain's resistance pattern.
Other Antibiotics
The Centers for Disease Control and Prevention categorizes extensively drug-resistant tuberculosis as tuberculosis bacteria that are resistant to at least isoniazid and rifampin among first-line drugs; any fluoroquinolone; and at least one second-line injectable. These bacteria can be difficult to treat. Options available include ethionamide, cycloserine, p-aminosalicylic acid, protionamide and terizidone, according to the World Health Organization.
References
- Centers for Disease Control and Prevention: Treatment for TB Disease
- Francis J. Curry National Tuberculosis Center: Drug-Resistant Tuberculosis: A Survival Guide for Clinicians
- World Health Organization: Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis
- Centers for Disease Control and Prevention: Extensively Drug-Resistant Tuberculosis 1993-2006
