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.

Table 14.6  Symptom-based approach to management of anti-TB drug side-effects

Side-effectsDrugsManagement

(a) Minor (continue anti-TB drugs)

Decreased appetite, nausea, abdominal painrifampicin pyrazinamideGive tablets with small meals or last thing at night
Joint painspyrazinamideAspirin
Burning sensation in the feetisoniazidPyridoxine 100 mg daily
Orange/red urinerifampicinReassurance; symptom is harmless
Itching, skin rashstreptomycin; rifampicin or isoniazidRefer to higher health facility where TB treatment is available

(b) Major (stop the drug(s) responsible)

DeafnessstreptomycinRefer to higher health facility where TB treatment is available
Dizziness (vertigo, imbalance and loss of balance)streptomycinRefer to higher health facility where TB treatment is available
Yellowish discoloration of the eye (hepatitis)most anti-TB drugsRefer to higher health facility where TB treatment is available
Vomiting and confusionmost anti-TB drugsRefer to higher health facility where TB treatment is available
Visual impairmentethambutolRefer to higher health facility where TB treatment is available
Shock, skin rash and decreased urine outputrifampicinRefer 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.

14.3.5  Treatment of TB patients under Directly Observed Treatment (DOTS)

Summary of Study Session 14