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Streptomycin This was the first drug introduced for the treatment of tuberculosis. It must be given by injection, as it is not absorbed through the intestines. This limits its long-term use. It is. bactericidal for extracellular (including cavity) tubercle bacilli through a direct action of inhibiting protein synthesis. It has been found valuable for out patient treatment in which it is given twice or thrice a week, along with two oral drugs prescribed daily. It is also useful during the stage of intermittent therapy. Unfortunately resistance develops rapidly and thus ethambutol is preferred in its place. Adverse Effects: When administered correctly, streptomycin is rarely toxic. Occasional transient headaches may occur. Decreased sensation around the face and a tingling sensation in the hands occur in 15% patients but they are not troublesome. It may cause a derangement of labyrinthine function (organ for maintaining posture) when given in high doses during decreased kidney function or in older patients. Precautions Consult the doctor if there is difficulty in maintaining posture occurs. Avoid its use during pregnancy to avoid possible hearing loss in the foetus. Its use with ethacrynic acid and furosemide should be avoided as these increase its toxicity on the ears and kidney. Its use with cephalosporin and polymyxin antibiotics should be avoided as these can damage the kidneys. Patients of kidney disease should always inform the doctor before using streptomycin. Second Line Drugs These drugs are used in Multi Drug Resistant TB cases The safety and efficacy of these drugs is less than first line drugs. They are also more expensive and are required in more numbers for treatment of multi drug resistant cases. New Second Line Drugs Ciprofloxacin, Ofloxacin, Sparfloxacin, Levofloxacin These antibacterial drugs have shown good activity against tubercular microbes and at present are used in multidrug resistant (MDR) cases. Clarithromycin, Azithromycin These drugs have been used in a typical mycobacterial infections (affecting lungs and skin) particularly in patients with HIV infection. Rifabutin is another drug used in atypical infections. Fixed Dose Combinations (FDCs) of Antitubercular drugs Nowadays FDCs of antitubercular drugs are being increasingly used and are also approved by the WHO. A major advantage is that these simplify use of drugs by patients and rationalize the supply. With the use of drugs, tuberculosis can be controlled very effectively and patient is cured with regular treatment taken without any break and full course is completed. It is generally observed that almost all patients take treatment regularly for initial 2-3 months, however, as they improve, they start ignoring regularity and miss quite a number of doses. It is at this point of time that care is required to continue treatment even when the person is without symptoms. Antitubercular drugs are supplied free of cost at all the urban and rural health facilities.
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