Which drug is NOT part of RIPE therapy?

• A. Ethambutol
• B. Rifampin
• C. Streptomycin
• D. Pyrazinamide

Answer: (C)

RIPE therapy uses four first-line drugs for treating drug-susceptible tuberculosis: rifampin, isoniazid, pyrazinamide, and ethambutol. Streptomycin is not part of this standard four-drug combination. It’s an older aminoglycoside that has been used in TB treatment, but today it’s considered a second-line option or reserved for specific situations rather than a core component of the RIPE regimen. The four drugs in RIPE work together to rapidly kill actively growing TB bacteria (rifampin and isoniazid) and to shorten therapy (pyrazinamide), with ethambutol helping prevent resistance during the early phase. Because of safety concerns and the effectiveness profile of the first-line agents, streptomycin is not routinely included in RIPE.