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SEROMYCIN (CYCLOSERINE): PRECAUTIONS
Precautions Related to Treatment of Tuberculosis
Cycloserine (Seromycin) capsules should not be used alone for treatment of active (clinical) TB; must be given in conjunction with other antituberculosis agents.
Clinical specimens for microscopic examination and mycobacterial cultures and in vitro susceptibility testing should be obtained prior to initiation of antituberculosis therapy and periodically during treatment to monitor therapeutic response. The antituberculosis regimen should be modified as needed. Patients with positive cultures after 4 months of treatment should be considered to have failed treatment (usually as the result of noncompliance or drug-resistant TB). Cycloserine in vitro susceptibility testing may be technically difficult.
If Cycloserine (Seromycin) is added as a new drug to a regimen in patients experiencing treatment failure who have proven or suspected drug-resistant TB, at least 2 (preferably 3) new drugs known or expected to be active against the resistant strain should be added at the same time.
Compliance with the full course of antituberculosis therapy and all drugs included in the multiple-drug regimen is critical. Missed doses increase the risk of treatment failure and increase the risk that M. tuberculosis will develop resistance to the antituberculosis regimen.
To ensure compliance, ATS, CDC, IDSA, and AAP recommend that directly observed (supervised) therapy (DOT) be used for treatment of active TB whenever possible, especially when intermittent regimens are used, when the patient is immunocompromised or infected with HIV, or when drug-resistant M. tuberculosis is involved.
Vitamin B12 and/or folic acid deficiency, megaloblastic anemia, and sideroblastic anemia have been reported in patients receiving cycloserine in conjunction with other antituberculosis agents.
If anemia occurs, initiate appropriate studies and therapy.
Monitor renal, hepatic, and hematologic function while taking Cycloserine (Seromycin) capsules.
Monitor cycloserine concentrations; measure concentrations at least once weekly in those with reduced renal function, in those receiving > 500 mg daily, and in those showing signs and symptoms that suggest toxicity. Adjust dosage to maintain serum concentrations < 30 mcg/mL.
Seromycin (Cycloserine) related pharmaceutical drugs and medications
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