1 itching / rashes - isoniazid

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