Ready Reckoner for Health Workers
Ready Reckoner for Health Workers
Side effects associated with anti-TB drugs and their prevention and management
Important general instructions
- Ensure that patient completes full course of anti-TB therapy
- Side effects of anti-TB drugs can be an important cause of patient stopping medication, especially with second line drugs
- Prevention and early detection of side effects are needed
- Alcohol, smoking and use of illicit drugs increase side effects
- Relevant history, clinical examination and lab tests are important to evaluate risk factors and diagnosis of side effects at an early stage
- For contraception, ask patient to seek advice from family planning center as oral contraceptives are less effective with some anti-TB drugs
- Educate, counsel and reassure patients for self-limiting side effects
- Side effects and serious side effects requiring immediate action —- refer patients to Medical officer
- Report serious side effects to PvPI center (Procedure for reporting: Call your nearby PvPI center and provide complete information about side effect. ; Contact no: National toll free number: 18001803024)
- Advice nutritious diet to TB patients
- Advice patients about respiratory hygiene and provide information on preventing spread of TB (Cover nose and mouth with facemask, tissue paper)
Some common and rare side effects of anti-TB drugs
| Common (Seen in 1-10% patients) | Rare (Seen in less than 1% patients) |
|---|---|
| Nausea, Vomiting, Gastritis,Hepatitis,Hypersensitivity reactions,Cutaneous reactions | Flu like syndrome, Peripheral neuropathy, Ocular toxicity, Dysglycemia,Gynaecomastia, Hypothyroidism, Joint related side effects,Tendinopathy and tendinitis, Myelosuppression, Anaemia, Thrombocytopenia,Psychosis, Seizures, Prolongation of QT interval |
Symptoms, causative drugs and action to be taken by Health worker
| Symptoms | Which drugs cause | Action by Health Workers |
|---|---|---|
| Upper abdominal pain – Frequent | All oral anti-TB drugs | Indicates gastritis. Advise patients to increase fluid intake. Patients should not take antacids/acid lowering agents together with first line anti-TB drugs as it reduces the absorption of drugs. Refer to Medical Officer. |
| Nausea, vomiting | All oral anti-TB drugs | Reassure patient. Advice patient to take drugs embedded in a banana. Give drugs with less water and over a longer period of time (e.g. 20 minutes). However, later in the day, patients should take sufficient water. If above measures fail, refer to Medical Officer. |
| Nausea, vomiting with yellowness of skin and dark colour urine | Mainly by Pyrazinamide, Rifampicin and Isoniazid | Indicates Liver toxicity. Refer to Medical officer urgently |
| Loose motions >4 times, liquid stools | Mainly by PAS, Ethionamide, Isoniazid, Rifampicin, Ofloxacin, Levofloxacin, Moxifloxacin | Counsel patients on food and personal hygiene. Advice 200 ml Oral rehydration solution (ORS) after every loose stool to maintain hydration. Refer to Medical officer. |
| Loose motions associated with dryness of skin and mouth decreased urination, tiredness and sunken eyes | Same as above | Indicates Dehydration (Serious) Refer to Medical officer urgently |
| Itching / Rashes | Mainly by Ethambutol,Rifampicin,Streptomycin | Reassure patient. If rash persists, refer to Medical Officer |
| Itching / Rashes involving very large body area or present in mouth, nose associated with swelling and fever | Mainly by Ethambutol,Rifampicin Streptomycin | Indicates systemic involvement (Serious) Refer to Medical officer urgently |
| Tingling /burning /numbness in hands and feet | Mainly Isoniazid, Cycloserine | Check that patientis taking Pyridoxine. Refer to Medical officer. |
| Pain in Joints | Mainly Pyrazinamide | Paracetamol can be given if only 1-2.joints are involved. Reassure patient that it is a self-limiting condition. If > 2 joints are involved or pain is not relieved, refer to Medical officer. |
| Impaired vision: Pain, Blurring of vision, Disturbance in color vision | Mainly Ethambutol | Indicates Eye toxicity.Refer to Medical officer urgently |
| Flu-like syndrome: Chills, dry cough, shortness of breath, loss of appetite, body ache, malaise | Which drugs cause Mainly Rifampicin | Reassure patient. If not controlled, refer patient to Medical Officer for evaluation. |
| Swelling of face or legs, less or no urine | Amikacin, Kanamycin, Capreomycin, Streptomyin | Indicates Kidney toxicity.Refer to Medical officer urgently |
| Seeing abnormal things, change of thoughts, suicidal thoughts | Mainly Cycloserine | Indicates Psychiatric disturbances.Refer to Medical officer urgently |
| Tiredness, lethargy, headache,giddiness, pale look, palpitations | Mainly Linezolid, Isoniazid, Rifampicin, Pyrazinamide, Ofloxacin, Levofloxacin,Moxifloxacin | Indicates Anemia. Patients can be advised rest in DOTS center post-dosing to avoid giddiness. Advice patients on nutritionRefer to Medical Officer for evaluation. |
| Ringing in ears, Loss of hearing, dizziness and loss of balance leading to recurrent fall | Mainly Streptomycin, Amikacin, Kanamycin, Capreomycin | Indicates Ear toxicity.Refer to Medical officer urgently |
| Slowness of activities, swelling of face, swelling in neck, disproportionate weight gain | Mainly PAS and Ethionamide | Indicates Thyroid involvement.Refer to Medical officer urgently |
| Pain and swelling in muscles and Tendons, difficulty in movement | Ofloxacin, Levofloxacin and Moxifloxacin | Indicates Tendonitis.Refer to Medical officer urgently |
| Seizure: Convulsion | Isoniazid, Cycloserine, Ofloxacin, Levofloxacin, Moxifloxacin | Refer to Medical officer urgently |
| Orange and reddish color of urine sweat, phlegm (sputum), saliva or tears may be noticed. As this is quite common with rifampicin, reassure patients. | ||
Source:
Last Modified : 2/12/2020
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