If a patient cannot tolerate INH, what is a common alternative treatment?

The selection of rifampin as a common alternative treatment for patients who cannot tolerate isoniazid (INH) is based on its efficacy in treating tuberculosis. Rifampin is a key medication in tuberculosis regimens, particularly because it works by inhibiting bacterial DNA-dependent RNA polymerase, effectively disrupting RNA synthesis in the mycobacterium and thereby reducing bacterial load.

When a patient cannot tolerate INH due to potential side effects such as hepatotoxicity or peripheral neuropathy, rifampin remains an effective choice owing to its broad-spectrum action and ability to achieve high levels in bodily fluids and tissues, helping to eradicate the infection. It is commonly used in combination with other anti-tuberculosis agents to enhance treatment effectiveness and prevent the emergence of drug-resistant strains.

Options like streptomycin, ethambutol, and pyrazinamide, while also part of tuberculosis treatment regimens, are not typically considered first-line alternatives to INH when it comes to replacing it due to tolerance issues. Streptomycin is an injectable aminoglycoside that can be less convenient and has a risk of ototoxicity. Ethambutol is used primarily to counteract resistance and is not a direct replacement for INH due to its