14.4 Side-effects of anti-TB drugs and their management
14.4.1 Types and severity of side-effect
Side-effects are unwanted symptoms, discomfort or more serious adverse (harmful) consequences of drug treatment. Serious side-effects are rare in patients taking anti-TB drugs. A minority of TB patients treated with Category I or Category II regimens experience adverse side-effects categorised as:
- major adverse side-effects giving rise to serious health concerns that require the stopping of anti-TB treatment
- minor side-effects causing relatively little discomfort and often responding to simple treatment of the symptoms; they may occasionally persist for the whole period of anti-TB treatment.
Possible side-effects of the anti-TB drugs and their management are listed in Table 14.6.
| Side-effects | Drugs | Management | |
|---|---|---|---|
(a) Minor (continue anti-TB drugs) | Decreased appetite, nausea, abdominal pain | rifampicin pyrazinamide | Give tablets with small meals or last thing at night |
| Joint pains | pyrazinamide | Aspirin | |
| Burning sensation in the feet | isoniazid | Pyridoxine 100 mg daily | |
| Orange/red urine | rifampicin | Reassurance; symptom is harmless | |
| Itching, skin rash | streptomycin; rifampicin or isoniazid | Refer to higher health facility where TB treatment is available | |
(b) Major (stop the drug(s) responsible) | Deafness | streptomycin | Refer to higher health facility where TB treatment is available |
| Dizziness (vertigo, imbalance and loss of balance) | streptomycin | Refer to higher health facility where TB treatment is available | |
| Yellowish discoloration of the eye (hepatitis) | most anti-TB drugs | Refer to higher health facility where TB treatment is available | |
| Vomiting and confusion | most anti-TB drugs | Refer to higher health facility where TB treatment is available | |
| Visual impairment | ethambutol | Refer to higher health facility where TB treatment is available | |
| Shock, skin rash and decreased urine output | rifampicin | Refer to higher health facility where TB treatment is available | |
In the next study session we turn to the subject of following-up patients and tracing patients who are not taking their medication.
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14.3.5 Treatment of TB patients under Directly Observed Treatment (DOTS)