A SEMINAR ON

Tuberculosis.
By
SAI KUMAR.D.
Reg.No.06171R0037

Under the guidance of

Ms.M PRAVEENA KUMARI, M Pharm.
BHARAT INSTITUTE OF TECHNOLOGY
Tuberculosis
 It is a bacterial infection.
 Caused by mycobacterium

tuberculosis (also called tubercle bacillus)

 Damages a person lungs and other parts of body

 Fatal if not treated properly

TRANSMISSION
 Spreads through the air when a person with
active TB
• coughs
• speaks
• laughs
• sneezes

 Another person breathes in the bacteria and

becomes infected
INSIDE THE BODY
 Once inhaled by a tuberculin free person, the bacilli
multiply 4-6 weeks and spreads through out the body.
The bacilli implant in areas of high partial pressure of
oxygen:
 Lung
 Renal cortex
 Reticuloendothelial system
SYMPTOMS
 Perpetual cough
 Fever

 Weight loss
 Pain while breathing

 Loss of appetite

 Fatigue

 Swollen glands

 chills
DIAGNOSIS
Skin test- mantoux test
 Purified protein derivative-PPD
Injected in forearm and examined
2-3 days later
 Red welt around site of injection indicates

infection
 Other test:

 The heaf test

 The tine multiple puncture test
CLASSIFICATION OF DRUGS
 Depending upon the degree of effectiveness and potential side effects
 First line drugs: (primary agents)
 Are the most effective and lowest toxicity.

Isoniazid, Rifampicin
 Second line:
 Less effective and more toxic effects.

Pyrazinamide, Ethambutol, Streptomycin

 Third line:
 are least effective and most toxic.

Amikacin,Thiacetazone, Viomycin, Cycloserine

BACTERICIDAL AND
BACTERIOSTATIC DRUGS
 bacteriostatic drugs inhibit the growth of bacteria by
interfering with bacterial protein production, DNA replication,
or other aspects of bacterial cellular metabolism.
 bactericidaldrugs inhibit the multiplication of bacilli
and destroys the bacilli totally.
 Bactericidal drugs:
Rifampicin, Streptomycin, Pyrazinamide.
 Bacteriostatic drugs:
Ethambutol, Thioactazone.
RIFAMPICICN (RMP):
RMP is a powerful bactericidal drug. It permeates all tissue
membranes including the blood-brain and placental barriers.
RMP is specially used when the bacilli resists the other drugs.
It is effective against both intracellular and extra cellular
bacilli.
 M.O.A:

It acts by binding and inhibiting, DNA-dependent

RNA polymerase in bacilli.
 Toxic effects :
It includes hepatotoxicity, gastritis, influenza- like
illness, thrombocytopenia and nephrotoxicity.
ISONIAZID:
It is a bacteriostatic acting against resting organisms but can
Kill dividing bacteria.

 M.O.A:
The mechanism of action is not clear but, there is a evidence
that it inhibits the synthesis of Mycolic acid, important
constituents of the cell wall and peculiar to mycobacteria.

 Adverse Effects:
Fever,
Hepatotoxicity,
Haematological changes.
 PYRAZINAMIDE:
The drug is bactericidal and is particularly active against slow
multiplying intra cellular bacilli which are unaffected by other
drugs.

 The drug is given orally and the usual dose is 30mg/kg of body
weight divided into 2 or 3 doses per day. It is also used in
tuberculosis meningitis.

 Pyraniazide is inactivate at neutral PH but tuberculostatic at

acid PH.
 Toxic effects:
hepatotoxicity,
hyperuremia,
 ETHAMBUTOL:
Ethambutol is bacteriostatic and is used in combination to
prevent the emergence of resistance to other drugs. It is given
orally. Ethambutol has replaced para amino salicylic acid (PAS)
almost entirely in adults
THIACETAZONE:
It is companion drug to isoniazid that is commonly used in
India. The usual dose is 2 mg/kg body weight
 Toxic effects:

gastrointestinal disturbances, bluring of vision,

haemolytic anemia
TREATMENT
CHEMOTHERAPY:
Chemotherapy of tuberculosis is the new advancement in
this century. The objective of the treatment is elimination
of both the fast and slowly multiplying bacilli from the
patients body.
Two phase chemotherapy
• The first is short, lasting 1-3 months. During the
intensive phase 3 or more drugs are combined to
kill as many bacilli as possible
• The second is aimed at sterilizing the small number
of persisting bacilli.
 SHORT COURSE CHEMOTHERAPY:

It is also called as “Directly observed treatment” (DOTS).

 In DOTS treatment a trained person watches the patient as he

swallows the drug in his presence and confirming that the drug is
taken in intensive phase.

 During continuation phase the patient is issued a medicine for

one week in a multi-blister combipack in the purpose of
successful chemotherapy by regular and adequate intake.
VACCINES
Bacilli calmette guerin(BCG):
 BCG is the current available oral vaccine available today for
protection against tuberculosis.
 It contains live weakened strains of mycobacterium bovis. It
was first used in 1921 against tuberculosis.
 Today it is estimated that more than 1 billion people have
received BCG and the safety of this vaccine has not been a
issue until recently.
 BCG vaccine is given at any time from birth to 15 days of
life along with zero dose of oral polio vaccine as
recommended by Govt. of India.
 BCG vaccine is given on left arm. A wheel or swelling of
6mm is raised above the surface. No spirit is applied
before the injection.
• BCG should be given as early as possible in life, before child
comes in contact with tuberculosis.
• BCG can be given with other vaccines except measles and
MMR.
• Immediately after BCG vaccine there is a small swelling at
the injection site which persists up to 6-8 hrs.
• After that swelling disappears and looks like a mosquito bite.
After that it forms a small nodule which breaks open and
discharges fluid and forms ulcer.
• That heals by a scar the whole process takes up to 2-5
weeks. If scar not formed until 6 months Mantoux test is
done if it shows negative BCG vaccine is repeated.
TUBERCULOSIS AND HIV
o World wide the number of people infected with both HIV and
tuberculosis are rising.
 The disease enters when the HIV kills the normal immune
system of the patient and kills the patient which is frequently
seen in HIV +ve people.
 It is cured by proper TB control program and extending the
life of HIV +ve people.
 Good TB control program (DOTS) is the largest thing that can
be done to control, cure and extend the life of HIV +ve people.
THE FUTURE
 Despite effective case finding and therepeutic tools and
declines in mortality rates in some countries
tuberculosis, appears to continue as an important
communicable disease problem world wide for several
decades of life.
 The high prevalence of infection rates in some
countries, the emergence of drug – resistant strains,
association of tuberculosis with HIV infection and above
all, the perpetuation of the “Non-specific determinants”
of the disease in the third world countries made a rapid
conquest of the disease.
THANK YOU