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Anti-TB drugs

Anti-TB drugs were previously divided into 2 groups:
a) drugs of the first row (basic antibacterial);
b) second-line drugs (reserve).
K The first-line drugs, which are the main chemotherapeutic agents for the treatment of various forms of tuberculosis, included isonicotinic acid hydrazide (isoniazid) and its derivatives, antibiotics (streptomycin - see), PASK and its derivatives. A highly effective anti-tuberculosis drug is rifampicin (see).
K The second-line drugs included ethionamide, protionamide, ethambutol, cycloserine, pyrazinamide, thioacetazone, kanamycin (see), florimycin.
Second-line drugs (reserve) are less active in action on tuberculosis mycobacteria than isoniazid and streptomycin; their main feature is that they act on mycobacteria that have become resistant to drugs of the first row.
Antituberculous drugs of the first row are highly effective, but with their use, the resistance of tuberculosis mycobacteria develops quite quickly. With the isolated use of one drug, resistant forms of mycobacteria can appear after 2 - 4 months.
The development of resistance of mycobacteria occurs much more slowly with the simultaneous use of different drugs. Therefore, modern antibiotic therapy for tuberculosis is a combination. A patient is prescribed 3 or 2 drugs at the same time, and drugs of the first row (for example, isoniazid with streptomycin and PASK) or of the first and second row (for example, isoniazid with cycloserine or with ethionamide, etc.) can be combined.
Anti-TB drugs are also distributed according to their degree of effectiveness. Isoniazid, which is the main drug, has the highest bacteriostatic activity, especially in the treatment of newly diagnosed patients with tuberculosis, and then rifampicin. The remaining drugs are distributed according to activity as follows: streptomycin> kanamycin> pyrazinamide> ethionamide = protionamide> ethambutol> cycloserine> florimycin> PASK> thioacetasone.
Most anti-TB drugs act on mycobacterium tuberculosis bacteriostatically, inhibiting their reproduction and reducing their virulence. Isoniazid and rifampicin can act bactericidal in high concentrations.
To obtain a lasting therapeutic effect and prevent possible relapses, anti-TB drugs should be used for a long time.
The choice of drugs and the duration of their use depend on the form of tuberculosis and its course, previous treatment, the sensitivity of tuberculosis mycobacteria to the drug, its tolerance, etc.
When combining drugs, 1 or 2 drugs of the first row should be kept in combination, especially isoniazid, if there are no contraindications or drug resistance to it.
With combined use, the dose of each of the drugs taken is usually not reduced.
It should be borne in mind that it is impossible to combine streptomycin and its derivatives and combined preparations containing it with kanamycin, florimycin and other antibiotics that have nephroid and ototoxic effects.