Pharmacologic Profile

General Use

Used in the treatment and prevention of tuberculosis. Combinations are used in the treatment of active tuberculosis to rapidly ↓ the infectious state and delay or prevent the emergence of resistant strains. In selected situations, intermittent (twice weekly) regimens may be employed. Streptomycin is also used as an antitubercular. Rifampin is also used in the prevention of meningococcal meningitis and

Haemophilus influenzae

type B.

General Action and Information

Kill (tuberculocidal) or inhibit the growth of (tuberculostatic) mycobacteria responsible for causing tuberculosis. Combination therapy with two or more agents is required, unless used as prophylaxis (isoniazid alone).

Contraindications

Hypersensitivity. Severe liver disease.

Precautions

Use cautiously in patients with a history of liver disease or in elderly or debilitated patients. Ethambutol requires ophthalmologic follow-up. Safety in pregnancy and lactation not established, although selected agents have been used without adverse effects on the fetus. Compliance is required for optimal response.

Interactions

Isoniazid inhibits the metabolism of phenytoin. Rifampin significantly ↓ levels of many drugs.

Nursing Implications

Assessment

• Mycobacterial studies and susceptibility tests should be performed prior to and periodically throughout therapy to detect possible resistance.
• Assess lung sounds and character and amount of sputum periodically throughout therapy.

Potential Nursing Diagnoses

• Risk for infection (Indications)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)
• Noncompliance (Patient/Family Teaching)

Implementation

• Most medications can be administered with food if GI irritation occurs.

Patient/Family Teaching

• Advise patient of the importance of continuing therapy even after symptoms have subsided.
• Emphasize the importance of regular follow-up exams to monitor progress and check for side effects.
• Inform patients taking rifampin that saliva, sputum, sweat, tears, urine, and feces may become red-orange to red-brown and that soft contact lenses may become permanently discolored.

Evaluation/Desired Outcomes

• Resolution of the signs and symptoms of tuberculosis. Negative sputum cultures.

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