Drugs used in Drug-resistant Tuberculosis (DR-TB) treatment may cause some common adverse effects in patients (as can be seen in figure below). It is important to know these relevant Adverse Drug Reactions (ADRs) to help in their swift identification and management.
Figure: Common or relevant adverse effects of drugs used in DR-TB treatment; Source: Guidelines on PMDT, India 2019, draft version, p115.
Resources
Paradoxical Reaction
Occasionally, patients with HIV-related TB may experience a temporary exacerbation of symptoms, signs, or radiographic manifestation of TB after beginning TB treatment due to simultaneous administration of Anti-retroviral Treatment (ART) and TB medication. It was thought to be a result of immune reconstitution and is referred to as the Immune Reconstitution Inflammatory Syndrome (IRIS).
Symptoms and Signs
Pregnancy is not a contraindication for the treatment of Drug-resistant TB (DR-TB) but poses a great risk to both the mother and the foetus. All women of child-bearing age should be tested for pregnancy as part of the pre-treatment evaluation and whilst on treatment. Pregnant DR-TB patients need to be monitored carefully both in relation to the treatment and the progress of the pregnancy.
The table below provides the details about the clinical evaluation and laboratory tests that need to be done during Pre-treatment Evaluation (PTE) to initiate patients on shorter injectable-containing Multidrug-resistant (MDR)/ Rifampicin-resistant Tuberculosis (RR-TB) regimens.
Management of Hepato-toxicity During Treatment with H Mono/Poly DR-TB Regimen
State Airborne Infection Control [AIC] Committee: Terms of Reference [ToR]
State Programmatic Management of Drug-resistant TB (PMDT) Committee
Management of Prolonged QTcF During Treatment with Shorter/Longer Oral MDR-TB Regimen
Management of QT Prolongation by Grade of Severity of ADR
Common or Relevant Adverse Effects of DR-TB Therapy