# Other Antibacterials and TB Drugs for NEET PG Pharmacology: Fluoroquinolones, Aminoglycosides, Metronidazole, NTEP Regimens, BPaLM Source: https://tracknation.in/story/other-antibacterials-and-tb-drugs-for-neet-pg-pharmacology-fluoroquinolones-aminoglycosides-metronidazole-ntep-regimens-bpalm (TrackNation — free UPSC notes with PYQs) > NEET PG Pharmacology: macrolides, fluoroquinolones, tetracyclines, aminoglycosides, co-trimoxazole, clindamycin, metronidazole, nitrofurantoin and chloramphenicol, plus India's NTEP TB regimens (2HRZE/4HRE, BPaLM) and first-line drug toxicities, with a diagram, hooks, vignette MCQs and cards. ## Start Here 🎯 **Exam priority: Very high.** *Expect: the TB regimen and its toxicities, a tendon rupture on a fluoroquinolone, tooth staining in a child, deafness on gentamicin plus furosemide, metronidazole with alcohol or disulfiram, and chloramphenicol in a newborn.* CBME mapping: **PH 8.4–8.6**. TB regimens follow **NTEP**: the ICMR/NTEP drug-sensitive TB workflow (2022) and the DR-TB guidelines (November 2024). ## TB Drugs (NTEP) *TB regimens under NTEP and the key toxicity of each drug. Drawn by TrackNation.* - **Drug-sensitive TB**: 2HRZE/4HRE — 8 weeks (56 doses) of HRZE, then 16 weeks (112 doses) of HRE; only pyrazinamide is dropped. CNS and skeletal TB: continuation phase extended to 24 weeks. - **MDR-TB** = resistant to both H and R. **BPaLM** (bedaquiline, pretomanid, linezolid, moxifloxacin) for 26 weeks (up to 39), taken with food; pyridoxine reduces neuropathy. - **Linezolid in BPaLM**: optic neuritis of any grade → stop permanently; grade 2 neuropathy → reduce to 300 mg/day. ## Other Antibacterials | **Drug** | **Key warning (label)** | | Azithromycin | QT prolongation and torsades | | Levofloxacin (fluoroquinolone) | Boxed: tendinitis/tendon rupture, peripheral neuropathy, CNS effects, worsens myasthenia gravis; QT prolongation | | Doxycycline (tetracycline) | Permanent tooth discoloration if used in late pregnancy or under age 8; photosensitivity | | Gentamicin (aminoglycoside) | Nephrotoxicity, vestibular and auditory ototoxicity, neuromuscular blockade; avoid with furosemide | | Co-trimoxazole | Blocks folate synthesis (trimethoprim inhibits DHFR); SJS/TEN; hyperkalaemia at high (PCP) doses | | Clindamycin | Boxed: C. difficile-associated diarrhoea | | Metronidazole | Carcinogenic in rodents (avoid unnecessary use); encephalopathy, neuropathy; psychosis with disulfiram | | Nitrofurantoin | Pulmonary reactions; not if CrCl < 60 mL/min; not at term pregnancy (neonatal haemolysis) | | Chloramphenicol | Fatal blood dyscrasias including aplastic anaemia; gray syndrome in newborns | ## Traps the Examiner Sets - Rifampicin turns body fluids orange-red and makes the pill unreliable. - Ethambutol: check colour vision. Pyrazinamide: uric acid. Isoniazid: liver and nerves. - Isoniazid overdose: IV pyridoxine gram for gram. - No tetracyclines in late pregnancy or under 8 years. - Aminoglycoside + loop diuretic = more ototoxicity. ## Memory Hooks & Shortcuts *Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.* - 🧠 **RIPE: Red fluids (R), Isoniazid liver and nerves, Pyrazinamide uric acid, Eyes (E)** — first-line TB drug toxicities - 🧠 **2 then 4: HRZE then HRE** — intensive then continuation phase - 🧠 **Quinolones Quit tendons** — tendon rupture - 🧠 **Tetracycline Tints Teeth** — permanent discoloration under 8 years - 🧠 **Gentamicin + Furosemide = Fading hearing** — additive ototoxicity - 🧠 **Chloramphenicol Colours the baby Grey** — gray syndrome ## Rapid-Revision Cards - 2HRZE/4HRE: 56 + 112 doses, daily. - Continuation 24 weeks. - Resistant to H and R. - Bdq, pretomanid, Lzd, moxi; 26 wk (≤ 39); with food. - Optic neuritis → stop; grade 2 neuropathy → 300 mg. - Hepatitis (age), neuropathy; overdose: IV pyridoxine g-for-g. - Orange fluids; non-hormonal contraception. - Uric acid; LFTs; not in acute gout. - Optic neuritis; colour vision. - QTc; ECGs. - Tendon rupture, neuropathy, CNS, myasthenia; QT. - QT/torsades. - Teeth (late pregnancy, < 8 y); photosensitivity. - Nephro-, oto-toxicity, NM block; avoid with furosemide. - DHFR (TMP); SJS; hyperkalaemia. - C. difficile. - Disulfiram psychosis; neuropathy; rodent carcinogen. - Lungs; CrCl < 60 no; not at term. - Aplastic anaemia; gray baby. ## Sources *Facts in this article were checked against these documents.* - Standard Treatment Workflow: Drug-Sensitive Tuberculosis (NTEP) — Indian Council of Medical Research / Central TB Division, MoHFW, March 2022 - National Guidelines for Management of Drug-Resistant TB — Central TB Division, MoHFW (NTEP), November 2024 - Prescribing labels: Zithromax, levofloxacin, doxycycline, gentamicin, Bactrim, Cleocin, Flagyl, Macrobid, chloramphenicol, Rifadin, isoniazid, ethambutol, pyrazinamide, Sirturo — DailyMed, US National Library of Medicine, current labels, accessed November 2026 (link) - Competency Based Undergraduate Curriculum, Pharmacology (PH 8.4–8.6) — National Medical Commission, 2024 ## Test Yourself: Practice Questions Twenty-four questions in NEET PG style, most of them clinical vignettes. ## Practice Questions (NEET PG pattern) *Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.* **Q1.** A new sputum-positive patient with drug-sensitive pulmonary TB starts NTEP treatment. The regimen is - (a) 2HRZE / 4HRE, daily - (b) 2HRZE / 4HR thrice weekly - (c) 6 months of isoniazid alone - (d) BPaLM **Answer: (a)** — 8 weeks (56 doses) HRZE, then 16 weeks (112 doses) HRE. **Q2.** A child with tuberculous meningitis is on NTEP treatment. The continuation phase is - (a) replaced by BPaLM - (b) stopped after 4 weeks - (c) the same 16 weeks - (d) extended to 24 weeks **Answer: (d)** — CNS and skeletal TB need a longer continuation phase. **Q3.** In the continuation phase of drug-sensitive TB treatment, the drug that is stopped is - (a) isoniazid - (b) ethambutol - (c) pyrazinamide - (d) rifampicin **Answer: (c)** — NTEP: only pyrazinamide is stopped. **Q4.** A patient's TB is resistant to both isoniazid and rifampicin but sensitive to fluoroquinolones. NTEP's 6-month regimen is - (a) BPaLM: bedaquiline, pretomanid, linezolid, moxifloxacin - (b) isoniazid preventive therapy - (c) streptomycin alone - (d) 2HRZE/4HRE **Answer: (a)** — 26 weeks (extendable to 39), with food. **Q5.** On BPaLM, a patient develops blurred vision; optic neuritis is diagnosed. NTEP advises - (a) stopping linezolid permanently - (b) adding ethambutol - (c) halving linezolid - (d) continuing unchanged **Answer: (a)** — Optic neuritis at any grade → permanent discontinuation of linezolid. **Q6.** A woman on rifampicin for TB asks about her oral contraceptive pill. The label advises - (a) no change - (b) using non-hormonal contraception, as rifampicin lowers pill levels - (c) stopping TB treatment - (d) doubling the pill **Answer: (b)** — Rifampicin reduces oral contraceptive exposure. **Q7.** A patient two weeks into TB treatment is alarmed that his urine and tears are orange-red. This is due to - (a) rifampicin — harmless discoloration - (b) isoniazid hepatitis - (c) ethambutol - (d) haematuria from pyrazinamide **Answer: (a)** — Rifadin label (also stains soft contact lenses). **Q8.** An elderly man on isoniazid develops jaundice after several months of treatment. The label says isoniazid hepatitis - (a) is harmless - (b) can be severe or fatal, even after months, and its risk rises with age - (c) occurs only in the first week - (d) never happens in the elderly **Answer: (b)** — Boxed warning. **Q9.** A young woman takes a large overdose of isoniazid tablets and is fitting. The specific treatment is - (a) IV pyridoxine, gram for gram with the isoniazid dose - (b) N-acetylcysteine - (c) naloxone - (d) flumazenil **Answer: (a)** — Isoniazid label overdose section. **Q10.** A patient on TB treatment notices difficulty distinguishing red from green. The likely culprit is - (a) ethambutol optic neuritis - (b) rifampicin - (c) isoniazid - (d) pyrazinamide **Answer: (a)** — Test visual acuity and colour discrimination. **Q11.** On TB treatment, a man develops acute gout with a raised serum uric acid. The drug responsible is - (a) isoniazid - (b) ethambutol - (c) pyrazinamide - (d) rifampicin **Answer: (c)** — Baseline uric acid and LFTs; contraindicated in acute gout. **Q12.** Before and during bedaquiline therapy, the boxed warning requires - (a) audiometry - (b) ECG monitoring for QTc prolongation - (c) colour vision tests - (d) uric acid checks **Answer: (b)** — Sirturo boxed warning. **Q13.** A 60-year-old on levofloxacin for pneumonia develops an Achilles tendon rupture. This is - (a) gout - (b) fluoroquinolone-associated tendon rupture - (c) plantar fasciitis - (d) DVT **Answer: (b)** — Boxed warning: tendinitis, tendon rupture, neuropathy, CNS effects, myasthenia exacerbation. **Q14.** A woman with myasthenia gravis needs an antibiotic. Which class carries a boxed warning for worsening myasthenia? - (a) Nitrofurans - (b) Fluoroquinolones - (c) Cephalosporins - (d) Penicillins **Answer: (b)** — Levofloxacin label. **Q15.** A 5-year-old was treated repeatedly with a tetracycline. The permanent effect to expect is - (a) deafness - (b) aplastic anaemia - (c) tendon rupture - (d) yellow-grey-brown tooth discoloration **Answer: (d)** — Avoid in the last half of pregnancy and under age 8. **Q16.** A patient on doxycycline gets an exaggerated sunburn after a day outdoors. The label calls this - (a) photosensitivity - (b) porphyria - (c) lupus - (d) allergy to sunscreen **Answer: (a)** — Exaggerated sunburn reaction with tetracyclines. **Q17.** A patient with renal impairment on gentamicin is also given IV furosemide and becomes deaf and unsteady. The label explains - (a) aminoglycoside ototoxicity, worsened by potent diuretics - (b) vitamin B12 deficiency - (c) Meniere disease - (d) furosemide allergy **Answer: (a)** — Avoid gentamicin with ethacrynic acid or furosemide; vestibular and auditory toxicity. **Q18.** An HIV patient on high-dose co-trimoxazole for Pneumocystis pneumonia develops a high potassium. The cause is - (a) lab error - (b) trimethoprim at high dose raising potassium - (c) renal tubular acidosis from HIV only - (d) sulfamethoxazole causing hypokalaemia **Answer: (b)** — Reversible rise in serum potassium. **Q19.** A week after clindamycin, a patient has profuse diarrhoea. The label's boxed warning is - (a) tendon rupture - (b) QT prolongation - (c) C. difficile-associated diarrhoea - (d) ototoxicity **Answer: (c)** — Cleocin boxed warning. **Q20.** An alcoholic on disulfiram is given metronidazole and becomes acutely psychotic. The label - (a) recommends higher doses - (b) recommends adding alcohol - (c) says this is unrelated - (d) warns of psychotic reactions with disulfiram; don't combine **Answer: (d)** — Flagyl label; also encephalopathy and neuropathy. **Q21.** A 38-week pregnant woman has cystitis. Nitrofurantoin is - (a) contraindicated at term (risk of neonatal haemolytic anaemia) - (b) only given IV - (c) the best choice at term - (d) safe at any stage **Answer: (a)** — Also contraindicated if CrCl < 60 mL/min. **Q22.** An elderly woman on long-term nitrofurantoin develops cough and breathlessness. Suspect - (a) heart failure only - (b) TB reactivation - (c) asthma - (d) nitrofurantoin pulmonary reaction **Answer: (d)** — Acute, subacute or chronic pulmonary reactions; stop the drug. **Q23.** A newborn on high-dose chloramphenicol develops abdominal distension, vomiting, pallid cyanosis and circulatory collapse. This is - (a) methaemoglobinaemia - (b) kernicterus - (c) neonatal sepsis only - (d) gray syndrome **Answer: (d)** — Chloramphenicol also causes fatal blood dyscrasias, including aplastic anaemia. **Q24.** Co-trimoxazole's trimethoprim component inhibits - (a) cell-wall transpeptidase - (b) the 50S ribosome - (c) dihydrofolate reductase - (d) DNA gyrase **Answer: (c)** — The two components block two consecutive steps of folate synthesis. ### Active Recall From memory: give the NTEP drug-sensitive and MDR-TB regimens with durations, the key toxicity of each first-line TB drug and of bedaquiline and linezolid, and the main warning for fluoroquinolones, tetracyclines, aminoglycosides, co-trimoxazole, clindamycin, metronidazole, nitrofurantoin and chloramphenicol.