10.7 Adverse effects

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    Rapid and aggressive treatment of adverse effects is essential to improve tolerance and treatment outcomes.

    Some adverse effects should be routinely prevented (e.g. peripheral neuropathy).
    Most adverse effects cannot be prevented, but can be managed with symptomatic treatment (e.g. arthralgia due to pyrazinamide).
    Some adverse effects cannot be eliminated, but are not serious (e.g. skin discoloration due to clofazimine). Patients need reassurance and support to be able to tolerate them until they subside spontaneously.
    Some adverse effects can be serious (e.g. optic neuritis due to linezolid), which can lead to dose reduction or temporary or permanent interruption of the drug.


    Ascertaining which drug is responsible for a particular adverse effect can be challenging. Temporarily stopping a drug, or reducing the dose, can help identify the responsible drug.


    Adverse effects can appear at any time during treatment. Patients should be informed that they are likely to experience adverse effects and should report them immediately to health staff. Treatment supporters and nurses should rapidly report adverse effects to the clinician. Only the managing clinician can modify or stop a TB treatment.


    For the management of adverse effects, see Appendix 17.