Anti-Infective – Antitubercular

Now, the indications are two-fold mycobacterium and TB. Mycobacterium comes in many forms, focus only on the word “mycobacterium” and you will be fine. If you see mycobacterium, I want to immediately think antitubercular medications. And TB is again pulmonary or extrapulmonary (kidney, spine, brain).  Now these drugs aren’t medications a patient is going to get for a few days. These drugs are usually given for 6-9 months on strict regimen and require strict monitoring for compliance. Please refer to the tuberculous lesson in the respiratory course for more details.

Contraindications are based in the drug’s excretion route (kidney and liver). If you have liver or kidney failure, you will not properly dispose of the drug. I had a patient with liver disease, who was administered rifampin, that drug lingered their system for days, causing all kinds of havoc.

The side effect profiles are CNS and liver/kidney based. In the CNS, think ears, brain and eyes. And the drugs cause kidney and liver toxicity, which explains the contraindications mentioned earlier.

Alright, rifampin and isoniazid both have a unique side effect of red-orange-brown colored bodily secretions. I had a patient with orange sputum once, it’s something you will not forget and something you must educate your patients as a possible side effect or they will be in in the hospital freaking out! As, rightfully so.