Russian Pharmaceutical Industry Leader


Pharmacotherapeutic group
Antituberculosis drug
International name
Isoniazid + Pyrazinamide + Rifampicin + Ethambutol
Dosage form
Description Manufacturer Pharmacies Leave a feedback
Protub-4 is a fixed dose combination of rifampicin, isoniazid, pyrazinamide, and ethambutol. The combination use the active ingredients of the drug product reduces the risk of resistance that develops when they are used as monotherapy. Rifampicin Rifampicin mode of action is the inhibition of DNA dependent RNA-polymerase. Rifampicin has a bactericidal effect against both intra- and extracellular microorganisms. Isoniazid Isoniazid shows a bactericidal effect mainly against actively replicating Mycobacterium tuberculosis. Its mode of action is the inhibition of the synthesis of mycolic acids, a component of Mycobacterium cell wall. The minimum inhibitory concentration (MIC) of isoniazid for Mycobacterium tuberculosis is 0.05-0.025 mg/L. Resistance to isoniazid emerges slowly. Pyrazinamide Pyrazinamide has a bactericidal effect at an acid pH. It is assumed that pyrazinamide needs to be converted by an enzyme into pyrazinoic acid, its active form, in order to produce its bactericidal effect. Susceptibility of various M. tuberculosis strains to pyrazinamide depends on the enzymatic activity that can be measured in vitro thereby assessing susceptibility of a given strain. At acid pH, MIC of pyrazinamide is 20 mg/L in vitro. Pyrazinamide has no effect against atypical bacteria. Ethambutol Ethambutol is a bacteriostatic agent effective against M. tuberculosis resistant to other anti-TB drugs. Ethambutol prevents the bacterial wall formation by inhibiting incorporation of mycolic acids into it. It is active against almost all Mycobacterium tuberculosis and M. bovis strains and also against non-tuberculous mycobacteria (M. kansasii).
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