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150 PART 3 Antimycobacterial Drugs
Pore
Extractable
phospholipids
Mycolic acids
Arabinogalactan
Peptidoglycan
Cytoplasmic
membrane
Figure 21–1
Mycobacterial Cell Wall
The pharmacotherapy of mycobacterial disease
is complex. Combinations of drugs are always given
for patients with active disease to minimize the
development of resistance and shorten the duration
of therapy. These combinations interact with
each other and often with other medications that
the patient is on, because immunocompromised
patients are particularly vulnerable to mycobacterial
disease. Because mycobacteria grow slowly,
susceptibility testing takes weeks instead of days
to perform, so empiric regimens are often given for
extended durations. For tuberculosis, the standard
of care for patients with active infections is to start
with a four-drug regimen, so compliance and careful
watching for drug interactions are important.
First-line drugs for tuberculosis and Mycobacterium
avium-intracellulare complex (MAC)
are discussed in this section. Many second-line
drugs are available for tuberculosis; however,