Avoid using Second line
drugs of Kochs for ordinary UTI!!
What are
second line drugs for Kochs ?? This group of second
line drugs is therefore considered to be the most important component of the
core MDR-TB regimen. The
benefits from their use outweighs the potential risks. So they should always be
included unless there is an absolute contra-indication for their use.The order
of preference for the inclusion of the later generation fluoroquinolones in
MDR-TB regimens is:high-dose levofloxacin , all Fluoroquinolones
(levofloxacin or moxifloxacin), bed aquiline and linezolid are strongly
recommended for use in longer regimens, which are completed
with other drugs ranked by their relative balance of effectiveness to potential
toxicity.
·
·
moxifloxacin
·
& gatifloxacin
It is recommended that ofloxacin is phased out from MDR-TB regimens and that
ciprofloxacin is never used due to the limited evidence for their effectiveness Second
Line Drugs - Fluoroquinolones, second line injectable drugs
WHO recommendations on
the treatment of drug resistant TB
In December 2018 the
World Health Organisation (WHO) changed their recommendations on the second
line drugs to be used for the treatment of drug resistant TB. As the
treatment provided for many patients will lag behind the guidelines produced by
WHO, a summary of the 2016 recommendations are also provided here for
reference.
The guidelines published
by WHO provide extensive information, so the information provided here is just
a summary.
Second line drugs, recommendations after December 2018
The second line drugs to be
used for the treatment of drug resistant TB after 2018 are shown in the table
below.
The new guidelines mark a
major change in the recommended treatment to be provided for those on
"longer regimens".
Longer
MDR-TB regimens are treatments for MDR/RR-TB which last 18 months or more and
which may be standardized or individualized. These regimens are
usually designed to include a minimum number of second line TB medicines
considered to be effective based on patient history or drug resistance
patterns. The term "conventional" was previously used to refer to
such regimens but was discontinued in 2016 when WHO first issued a
recommendation for the use of a shorter MDR-TB regimen.
Injectable agents are no
longer among the priority medicines to be used when designing longer MDR-TB
regimens and WHO recommends that oral regimens should become the preferred
option for most patients. It is a major step forward in the treatment of
patients with drug resistant TB that patients are no longer required to have
injectable drugs.
Fluoroquinolones
(levofloxacin or moxifloxacin), bed aquiline and linezolid are strongly recommended for use in
longer regimens, which are completed with other drugs ranked by their relative
balance of effectiveness to potential toxicity.
|
Group A :
|
Group B :
|
Group C :
|
|
Levofloxacin (Lfx) or
Moxifloxacin (Mfx) |
Clofazimine (Cfz)
|
Ethambutol (E)
|
|
Bedaquiline (Bdq)
|
Cycloserine (Cs)
or Terizidone (Trd) |
Delamanid (Dlm)
|
|
Linezolid (Lzd)
|
Pyrazinamide (Z)
|
|
|
Imipenem-cilastatin (Ipm-Cln) or
Meropenem (Mpm) |
||
|
Amikacin (Am) (or Streptomycin)
|
||
|
Ethionamide (Eto) or Prothionamide (Pto)
|
||
|
p-aminosalicylic acid (PAS)
|
||
|
Second line drugs used
to treat rifampicin resistant and multi drug resistant
TB after December 2018
|
||
If a plus sign is shown,
clicking on it will show more columns.
All three medicines in
Group A should be included.
In group B one or both medicines should be included
Group C medicines should be included to complete the regimen when medicines from Groups A and B cannot be used.
In group B one or both medicines should be included
Group C medicines should be included to complete the regimen when medicines from Groups A and B cannot be used.
There is some further information about this on the page on
the Treatment of Drug
Resistant TB, and there is extensive information which should be consulted
in the WHO guidelines document.
Second line drugs, recommendations after
2016 and before 2018
In 2016 WHO changed their recommendations on the second line
drugs to be used for the treatment of drug resistant TB.2. The
second line drugs to be used for the treatment of drug resistant TB after 2016
were as follows.
|
Group A :
Fluoroquinolones
|
Group B : Second line
injectable drugs
|
Group C : Other core
second line drugs
|
Group D : Add-on drugs
(not part of the core MDR-TB regimen)
|
|
Levofloxacin (Lfx)
|
Amikacin (Am)
|
Ethionamide/Prothionamide (Eto/Pto)
|
D1 Pyrazinamide
|
|
Moxifloxacin (Mfx)
|
Capreomycin (Cm)
|
Cycloserine / Terizidone (Cs Trd)
|
D1 Ethambutol (E)
|
|
Gatifloxacin (Gfx)
|
Kanamycin (Km)
|
Linezolid (Lzd)
|
D1 High-dose isoniazid (Hh)
|
|
(Streptomycin)
|
Clofazimine (Cfz)
|
D2 Bedaquiline (Bdq)
|
|
|
D2 Delamanid (Dlm)
|
|||
|
D3 p-aminosalicylic acid
PAS)
|
|||
|
D3 imipenem-cilastatin (lpm)
|
|||
|
D3 Meropenem (Mpm)
|
|||
|
D3 Amoxicillin-clavulanate (Amx-Clv)
|
|||
|
D3 Thioacetazone (T)
|
|||
Groups A, B & C are
the core second line drugs.
If a plus sign is shown,
clicking on it will show more columns.
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