When To Stop Antitb Drugs

Eczema Free Forever

Eczema Free Forever Manual by Rachel Anderson

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When patients have minor drug side-effects, explain the situation, offer symptomatic treatment, and encourage them to continue treatment.

When a patient has a major reaction, stop the suspected responsible drug(s) at once. A patient who develops one of the following reactions must never receive that drug again:

Reaction Drug responsible

severe rash, agranulocytosis

thioacetazone

hearing loss or disturbed balance

streptomycin

visual disturbance (poor vision

ethambutol

and colour perception)

renal failure, shock, or

rifampicin

thrombocytopenia

hepatitis

pyrazinamide

SIDE-EFFECTS OF ANTI-TB DRUGS

SIDE-EFFECTS OF ANTI-TB DRUGS

Drug

Common side-effects

Rare side-effects

isoniazid

° peripheral neuropathy ° hepatitis if age > 40 ° sleepiness/lethargy

convulsions, pellagra, joint pains, agranulocytosis, lupoid reactions, skin rash, acute psychosis

rifampicin

° gastrointestinal: anorexia, nausea, vomiting, abdominal pain

° hepatitis

° reduced effectiveness of oral contraceptive pill

acute renal failure, shock, thrombocytopenia, skin rash, "flu syndrome" (intermittent doses), pseudomembranous colitis, pseudoadrenal crisis, osteomalacia, haemolytic anaemia

pyrazinamide

° joint pains ° hepatitis

gastrointestinal symptoms, skin rash, sideroblastic anaemia

streptomycin

° auditory and vestibular nerve damage (also to fetus) ° renal damage

skin rash

ethambutol

° optic neuritis

skin rash, joint pains, peripheral neuropathy

thiacetazone

° skin rash, often with mucous membrane involvement and sometimes blistering

hepatitis, agranulocytosis

I PRACTICAL POINT I

Rifampicin reduces the effectiveness of the oral contraceptive pill. Advise women to use another form of contraception.

I PRACTICAL POINT I

Warn patients that rifampicin colours all body secretions (urine, tears, semen and sweat) red or orange.

10.5.1 | Side-effects of anti-TB drugs in HIV-positive TB patients

Adverse drug reactions are more common in HIV-positive than in HIVnegative TB patients. Risk of drug reaction increases with increased immunocompromise. Most reactions occur in the first 2 months of treatment.

Skin rash

This is the commonest reaction. Fever often precedes and accompanies the rash. Mucous membrane involvement is common. The usual drug responsible is thioacetazone. Streptomycin and rifampicin are sometimes to blame. Severe skin reactions, which may be fatal, include exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis.

Other reactions

The commonest reactions necessitating change in treatment include gastrointestinal disturbance and hepatitis.There may be an increased risk of rifampicin-associated anaphylactic shock and thrombocytopenia.

Symptom-based approach to management of drug side-effects

Side-effects

Drug(s) probably responsible

Management

Minor

Continue anti-TB drugs

anorexia, nausea, abdominal pain

rifampicin

give tablets last thing at night

joint pains

pyrazinamide

give aspirin or nonsteroidal anti-inflammatory drug

burning sensation in feet

isoniazid

give pyridoxine 50-75 mg daily

orange/red urine

rifampicin

reassurance

Major

Stop drug(s) responsible

skin itching/rash

thioacetazone (streptomycin)

stop anti-TB drugs (see below)

deafness (no wax on auroscopy)

streptomycin

stop streptomycin, give ethambutol instead

dizziness (vertigo and nystagmus)

streptomycin

stop streptomycin, give ethambutol instead

jaundice (other causes excluded)

most anti-TB drugs

stop all anti-TB drugs until jaundice resolves (see below)

vomiting and confusion (suspected drug-induced pre-icteric hepatitis)

most anti-TB drugs

stop anti-TB drugs, urgent liver function tests

visual impairment

ethambutol

stop ethambutol

generalized, including shock and purpura

rifampicin

stop rifampicin

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