Drug of Choice of Tropical and Infectious diseases

>>Learn about Drug of Choice for various medical condition.

Pathology	Drug of Choice	2nd Line therapy	Remarks
Amoebic liver abscess	Metronidazole		Along with Luminal agent (Diloxanide furoate, parmomycin, Iodoquinol)
Anthrax	Penicillin G
Antibiotic Associated Pseudomembranous colitis	Metronidazole (IV)	Oral Rifampicin
Brucellosis	Doxycycline + aminoglycosiede fro 28 days		Continuation with Doxycycline + Rofampicin for next 4-6 weeks
Chlamydia	Tetracycline	Doxycycline
Cholera	Tetracycline	Doxycycline
Cryptococcal Meninigitis	Amphotericin B	± Flucytosine	With AIDS add Fluconazole
Falciparum malaria	Quinine
Guninea Worm infestation	Niridazole	Metronidazole
Herpes Simplex	Idoxuridine
Herpes Simplex Encephalitis	Acyclovir
Kalazar	Sodium Antimony Stibogluconate/ Pentavalent Antimony
Klebsiella Pneumonia	Gentamicin + 3rd Gen Cephalosporin
Legionella	Erythromycin
Meningococcal Meninigitis	Penicillin G		Prophylaxis: Rifampicin
Mucormycosis (Craniofacial)	Amphotericin B		Along with debridement
Multidrug resistant Typhoid	Ciprofloxacin
Neurocysticercosis	Albendazole	Praziquantel
Pneumoncystis Carini/jirovecii	Cotrimoxazole
Pneumonic Plague	Tetracycline		(Chemoprophylaxis)
Schistosoma Hematobium	Praziquantel	Oxamniquine
Taenia Solium/ Taenia Saginata	Praziquantel
Toxoplamosis /Ocular toxoplasmosis	Pyrimethamine		With Sulphadiazine/ Clindamyicn
Tropical Esosinophilia Syndrome	Diethyl Carbamazepine
Varicella zoster	Ayclovir

>>Learn about Drug of Choice for various medical condition.

2017 WHO Recommendation for treatment of TB . Things you must know !!!

2017 WHO Recommendation for treatment of TB : Things you must know !!!

1.     Drug and Dosing

a.      The 2017 guideline from WHO strongly suggest the use of RIFAMPICIN based drug regimen ( 2HRZE + 4HR) for 6 months compared to 4 months course with FLUOROQUINOLONE group of drug.

b.     Always use fixed dose combination formulation for treating drug susceptible TB   than individual drug regimen.

c.      The WHO recommends use of DAILY DOSING of drugs compared to THRICE A WEEK regimen in both intensive and continuation phase.

2.      HIV and PTB

a.      ART should be started in all patient living with HIV irrespective of CD4 counts.

b.     TB treatment should be started first followed by ART within 8 weeks (as early as possible). If CD4 cell count is less than 50, it should be started with in 2 weeks.

c.      A 6 months regimen of ATT is enough for patient under ART and 8 months course is not needed.

3.     Steroid

a.      WHO strongly recommends the initial use of steroid (Dexamethasone / Prednisolone) tapered over a period of 6-8 weeks in TB MENINGITIS. While the use of steriod of pericarditis the conditionally recommended.

4.     Retreatment

a.      Category II (2HRZES+1HRZE+5HRE) should no longer be prescribed  

without Drug sensitivity and testing.

Know about various Focuses and Complexes seen in Tuberculosis

The recommendations that still holds valid from 2010 are:

 

1.     Drug and Dosing

a.      New patient with PTB must receive 6 months of ATT therapy (2HRZE + 4HR) that is a Rifampicin based therapy and NOT that contains 2HRZE + 4HE.

b.     The use of daily dosing regimen should be practiced as far as feasible and twice daily dose should never be  used. There were recommendation for use of thrice weekly dose however the newer recommdation strongly favors use of daily dosing regimen.

c.      In areas with high resistance for Isoniazid, the expert recommend the use of HRE in continuation phase rather than HR alone.

d.     The extension of intensive phase is NOT recommended strongly even if the patient is not sputum negative at the end of Intensive phase

2.     TB and HIV

a.      WHO strongly recommends use of Rifampicin based therapy for the patients living with TB and HIV or patient living in high TB prevalent area.

b.     The duration should be NO LESS THAN those with HIV NEGATIVE status that is 6 months.There was suspicion over need of prolonged therapy but the newer recommedation suggests 6 month is sufficient.

c.      The DAILY DOSE THERAPY is recommended.

3.     Re-treatment

a.      The specimen for culture and sensitivity must be obtained in any patient going for re-treatment and sensitivity testing must be done at least for ISONIAZID and RIFAMPICIN.

b.     If possible the therapy should be guided based upon Rapid Molecular susceptibility testing.

For other details and full text follow the link to http://apps.who.int/iris/bitstream/10665/255052/1/9789241550000-eng.pdf?ua=1

Pupillary Reaction to Various Drugs and Substances

PUPIL REACTION TO SUBSTANCE/DRUGS

Pupil of human eye constrict and dilate depending upon the need of the eye to focus on near object/far object, dim light/bright light and whether it is under stress/not. This response is solely dependent upon the muscles inside the eyes in the iris. The pupillae constrictor muscle respond to cholinergic agents and cause pupillary constriction while the dilator pupillae muscle is acted upon by sympathetic system and causes pupillary dilation.

Beside these natural response, the substances we come in contact with can also alter the pupillary size. Drugs such as Adrenaline, antidepresssants, antihistaminics, can cause pupillary dilatation. Pethidine being an exception is the only opoid to cause pupillary dilation. Herbal products such as belladona, strychinine, calotropis and Chemicals such as alcohol, formic acid, cyanide Carbon monoxide also have dilatatory effect based upon the dosing.

Phenols, Organophosphate, carbamates, Carbolic acid, cause pupillary cosntriction. Drugs such as Opoids, barbiturates, Benzodiaepines, methyl dopa and plant product such as Nicotine, caffiene and opium causes the dilatation of pupil. 

Know how to assess the pupillary reaction or light reflex.

DILATORS		CONSTRICTORS
A6 C5 (Big1 Co Ca Cola Can)		O2 B2 C5 ( Car Car Caf )
Formic Acid			Phenol (Carbolic Acid)
Pethidine2 (only exception in Opoid)		O	All Opoids2  (Except severe Acidosis/hypoxia/ respiratory depression)
Adrenaline*/ Ephidrine/Sympathetomimetics	A		Parasympathetomimetics*
Atropine*/ Belladona/ Dhatura	A	O	Organophosphate*
Amphetamine	A	B	Barbiturates
Alcohol3	A	B	Benzodiazepines
Antidepressants	A
Antihistaminics	A
Cocaine Crack	Co	Car	Carbamate
Carbon Monoxide/ CO	Ca/CO	Car	Carbolic Acid
Calotropis	Cola	Caf	Caffeine
Cannabis	Can		Coma of Alcohol3
Cyanide			Clonidine
Hypothermia*			Heat Stroke*
Strychnine			Nicotine4
			Methyl Dopa

HIPPUS: Alternating dilatation and constriction is done by ACONITE

Note: All A’s constrict the pupil. All B’s and O’s dilate the pupil.

¹ Big is not a part of drug rather means dilatation.

² Only opoid to cause pupillary dilatation is Pethidine.

³ Toxic Effect of alcohol causes pupillary constriction as patient develops coma.

⁴ Delayed effect of Nicotine is dilatation of pupil.

* The drugs/substances in row with different color across the table are physiological Counterparts