Second Line Drugs for Tuberculosis

By  ,  Onlymyhealth editorial team
Mar 17, 2012

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The first-line treatment of tuberculosis includes a combination of drugs that are primarily used for treating tuberculosis. These first-line drugs are isoniazid, rifampin pyrazinamide, streptomycin and ethambutol. Second-line drugs for the treatment of tuberculosis are reserved for the treatment in special situations such as multidrug-resistant tuberculosis (MDR-TB), extensively drug-resistant tuberculosis (XDR-TB) or resistance to first-line therapy. Medications included in the second line treatment for tuberculosis are:

  • Capreomycin, ethionamide, para-aminosalicylic acid (PAS), cycloserine and streptomycin (SM).
  • Drugs used for treating patients with multidrug-resistant tuberculosis (MDR-TB) or extensively drug-resistant tuberculosis (XDR-TB) include some fluoroquinolones (eg, levofloxacin and moxifloxacin) and aminoglycosides (kanamycin and amikacin).

Information on Second Line Drugs

Drug- Capreomycin

  • Dosage- 15 – 30 mg/kg
  • Prior assessment- before the treatment, monitor vestibular and measure blood urea nitrogen during treatment.            
  • Note- Dosage may be reduced to two - three times per week after bacteriologic conversion. Safety and effectiveness in children have not been established

Drug- Ethionamide

  • Dosage- 15 - 20 mg/kg
  • Prior assessment- Measure hepatic enzymes.
  • Note-  Start with low dosage and increase with improved tolerance. If used with PAS, it may cause hypothyroid condition.

Drug- Para-aminosalicylic acid

  • Dosage- 150 mg/kg (16 g)
  • Prior assessment- Measure hepatic enzymes and monitor volume status.
  • Note- Start with low dosage and increase with improved tolerance. Cardiac patients must be monitored for sodium load. Used with ethionamid, it may cause hypothyroid condition.

Drug- Cycloserine

  • Dosage- 15 - 20 mg/kg (1 g)
  • Prior assessment- Assess mental status and serum drug levels.
  • Note- Initially, low dosage should be given and can be increased with improved toleration.

Drug - Levofloxacin

  • Dosage- 500 mg/day
  • Prior assessment- Drug interactions in the patient.
  • Note- Should not be used in children. After taking it, the patient may experience headache, restlessness, dizziness and hypersensitivity.

Are Second Line Drugs for Tuberculosis safe?

The principles of second line treatment for MDR-TB and XDR-TB are mostly the same. Their treatment mandates extensive chemotherapy sessions for up to two years. Second-line drugs can cause a number of side effects as they are toxic than the standard anti-TB regimen. Some side effects include hepatitis, depression and hallucinations. Patients require long isolated hospitalisation. Second-line drugs are extremely expensive when compared with the standard TB treatment. Success of second line treatment for tuberculosis depends on various factors such as the severity of the disease and their effect on immune system.

Important Note:


Dosage of second line drugs for children remains same as in adults. The dosage of these drugs is based on the patient’s weight and therefore, it should be adjusted as and when the patient’s weight changes. Consult an experienced doctor to know the right treatment for drug-resistant TB.


Read more articles on Tuberculosis Treatment.





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