3.20 Antituberculars

M. tuberculosis is the causative agent of tuberculosis (TB), a disease that primarily impacts the lungs but can infect other parts of the body as well. It has been estimated that one third of the world’s population has been infected with M. tuberculosis and millions of new infections occur each year. Treatment of M. tuberculosis is challenging and requires clients to take a combination of drugs for an extended time. Complicating treatment even further is the development and spread of multidrug-resistant strains of this pathogen. ^[1]

Indications for Use: Antitubercular medications are selective for mycobacteria work by inhibiting growth or selectively destroying mycobacteria.^[2]

Mechanism of Action: They work impacting the synthesis or transcription of mycobacteria RNA or inhibiting the synthesis of mycolic acids in the cellular wall. Mycobacteria can develop resistance to antitubercular medications; therefore, strict compliance to drug regimen must be emphasized.

Special Administration Considerations:  Antitubicular medications require at least six months of treatment. Many antitubercular medications may impact liver function, and liver enzymes should be monitored carefully. Other side effects to medication administration include GI symptoms, peripheral neuropathy, and vision changes.^[3]

Client Teaching/Education: Advise clients that medications must be taken as directed.  It is important that clients understand the significance of continuing drug therapy even after symptoms have resolved to prevent the spread of disease.  Drug therapy may be continued for six months to two years.  If a client notices any change in visual acuity or eye discomfort, it should be reported immediately to the healthcare provider.

Clients should also be advised to avoid alcohol during antitubercular therapy because of the increased risk of liver toxicity.  Foods containing tyramine such as tuna and Swiss cheese should be avoided.^[4]