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4. Multidrug therapies are instituted because of the
resistant organisms.

C. Multidrug-resistant strain of tuberculosis (MDR-TB)

1. Resistance occurs when a client receiving 2
medications (first-line and second-line medications)
discontinues 1 of the medications.
2. The client briefly experiences some response from the
single medication, but then large numbers of resistant
organisms begin to grow.
3. The client, infectious again, transmits the drug-
resistant organism to other individuals.
4. As this event is repeated, an organism develops that is
resistant to many of the first-line tuberculosis
medications.
D. General client education points for tuberculosis medications
1. Not to skip doses and to take medication for the full
length of the prescribed therapy
2. Not to take any other medication without consulting
with the PHCP
3. About the importance of follow-up PHCP visits and
laboratory tests
4. To avoid alcohol
5. To take medication on an empty stomach with 8 oz of
water 1 hour before or 2 hours after meals and to
avoid taking antacids with the medication
6. About the adverse effects that require PHCP
notification
7. Inform the client about direct observed therapy (DOT)
to ensure adherence to the medication regimen.
XIV. First-Line Medications for Tuberculosis (see Box 51-7)
A. Isoniazid
1. Description
a. Bactericidal
b. Inhibits the synthesis of mycolic acids
and acts to kill actively growing
organisms in the extracellular
environment
c. Inhibits the growth of dormant
organisms in the macrophages and
caseating granulomas
d. Is active only during cell division and is
used in combination with other
antitubercular medications

2. Contraindications and cautions

a. Contraindicated in clients with

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