Side effects of anti TB drugs and their management
1 itching / rashes - isoniazid
A ) itching without rash / mild rash - continue treatment and give anti tb drugs
B ) itching with severe rash - stop all drugs till symptoms subside , treat with antihistamines
C ) patients with mucosal involvement , fever , hypotension - will require treatment with corticosteroids
D ) when the reaction subside introduce drugs in small dosages and gradually increase over 3 days
2 Tingling / Burning / Numbness in hands and foot - isoniazid
A ) Give pyridoxine 100 mg / day orally or parentrally until symptoms disappear
B ) patient not responding to pyridoxine , give amitryptiline
3 Joint pains - pyrizinamide
A ) give NSAIDS like paracetamol , aspirin or ibuprofen
B ) give indomethacin in severe cases
C ) also estimate serum uric acid levels in severe cases
D ) give colchicine and ibuprofen - allopurinol will not work
E ) in severe cases , with normal or slightly elevated uric acid - consider reducing the dose
4 impaired vision - ethambutol
Stop drug for a week
5 ringing in ears , loss of hearing , dizziness and loss of balance - streptomycin
Is irreversible , stop and donot restart
6 hepatitis , anorexia , vomiting , jaundice - isoniazid , rifampicin , pyrizinamide
A ) rule out other causes
B ) donot restart until symptoms are present till 2 weeks
C ) if no improvement in levels - wait for jaundice to disappear
D ) if not change the drug with streptomycin and ethambutol