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Chapter 161. Antimycobacterial Agents

The physician is greatly challenged to provide optimal therapy for mycobacterial illnesses because of the increase in both drug-susceptible and multidrug-resistant tuberculosis; the increasing number of pathogenic nontuberculous mycobacteria (NTM); drug-related toxicities and drug-drug interactions (especially in patients who have AIDS, with their complex antiretroviral drug regimens); and the plethora of new antibiotics with antimycobacterial potential. | Chapter 161. Antimycobacterial Agents Table 161-1 Use of First-Line Antimycobacterial Agents in Patients with Renal or Hepatic Disease and in Pregnant Women Use in Indicated Circumstances Renal Disease Creatinine Clearance Rate Agent Severe Hepatic Disease 60 but 30 mL min 30 mL min Pregnancy Azithromycin No change No change Decrease dose No evidence of risk B Clarithromycin No change No change Decrease dose Risk cannot be ruled out C Ethambutol No change No change No change Risk cannot be ruled out C Isoniazid Avoid use or monitor carefully No change No change Risk cannot be ruled out C Pyrazinamide Avoid use or monitor carefully No change Decrease dose0 Risk cannot be ruled out C c Rifabutin No change No change No change No evidence of risk B Rifampin Avoid use or monitor carefully No change No change Risk cannot be ruled out C Rifapentine Avoid use or monitor carefully No change No change Risk cannot be ruled out C Streptomycin No change Decrease dose Decrease dose and frequency Definite evidence of risk D Based on Food and Drug Administration pregnancy categories of A-D X. bPrudent but not absolutely necessary. cUse in pregnancy is recommended by international organizations outside the United States. Antimycobacterial Agents Introduction The physician is greatly challenged to provide optimal therapy for mycobacterial illnesses because of the increase in both drug-susceptible and multidrug-resistant tuberculosis the increasing number of pathogenic nontuberculous mycobacteria NTM drug-related toxicities and drug-drug interactions especially in patients who have AIDS with their complex antiretroviral drug regimens and the plethora of new antibiotics with antimycobacterial potential. This chapter reviews the therapeutic agents used for treatment of tuberculosis leprosy Hansen s disease and diseases caused by NTM including the Mycobacterium avium complex MAC M. kansasii the rapidly growing mycobacteria and M. marinum. The use of first-line antimycobacterial agents .