DƯỢC LÍ Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th, 2010

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SECTION VII
CHEMOTHERAPY OF MICROBIAL DISEASES
hypersensitivity to antigens of M. leprae. Cutaneous ulcerations
and deficits of peripheral nerve function may occur. Early therapy
with corticosteroids or clofazimine is effective. Reactions in the
lepromatous form of the disease (erythema nodosum leprosum) are
characterized by the appearance of raised, tender, intracutaneous
nodules, severe constitutional symptoms, and high fever. This reaction
may be triggered by several conditions but is often associated
with therapy. It is thought to be an Arthus-type reaction related to
release of microbial antigens in patients harboring large numbers of
bacilli. Treatment with clofazimine or thalidomide is effective.
Therapy for Other Nontuberculous
Mycobacteria
Mycobacteria other than those already discussed can be recovered
from a variety of lesions in humans. Because they frequently are resistant
to many of the commonly used agents, they must be examined for
sensitivity in vitro and drug therapy selected on this basis. Therapy for
infections from these organisms is summarized in Table 56–5. In some
instances, surgical removal of the infected tissue followed by longterm
treatment with effective agents is necessary. M. kansasii causes
disease similar to that caused by M. tuberculosis, but it may be milder.
The microorganisms may be resistant to isoniazid. Therapy with isoniazid,
rifampin, and ethambutol has been successful.
CLINICAL SUMMARY
Combination therapy is almost always the desirable
approach for mycobacterial disease, to ensure effective
eradication and to prevent the emergence of resistance.
Isoniazid, rifampin, ethambutol, streptomycin, and
pyrazinamide are first-line agents for the treatment of
tuberculosis. Moxifloxacin promises to replace either
isoniazid or ethambutol and shorten therapy.
Antimicrobial agents with excellent activity against
Mycobacterium avium complex include rifabutin, clarithromycin,
azithromycin, and fluoroquinolones.
Clinical monitoring of patients with mycobacterial
infections is important because drug interactions and
adverse drug reactions are common with the multipledrug
regimens used. Considerable progress has been
achieved in eliminating leprosy through the use of multiple-drug
chemotherapy including dapsone, rifampin,
and clofazimine.
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