Cutaneous Adverse Drug Reactions Caused by Antituberculosis Drugs

Abstract

Multidrug antituberculosis regimen is associated with diverse clinical patterns of cutaneous adverse drug reactions (CADR), ranging from mild and moderate such as pruritus, maculopapular exanthems, lichenoid eruptions, fixed drug eruptions and urticaria to severe and even life threatening ones like acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These adverse reactions to antituberculosis drugs are commonly observed adverse events. This is of particular importance for high HIV prevalence settings and developing countries where tuberculosis is common infection resulting in higher occurrence rate of these reactions. There is still significant heterogenity in definition and classification of CADR, as well as diversity in treatment modalities following adverse reactions and rechallenge management. The aim of this review is to discuss clinical presentation, occurrence of CADR caused by antituberculosis drugs, to identify risk factors for intolerance of the standard therapy as well as to draw attention to importance of multi-disciplinary approach, early detection, prompt diagnosis and in time management of antituberculosis drugs associated CADR. CADR can cause significant treatment interruption and alteration, resulting in increased risk of treatment failure, drug resistance, relapses and increased risk of complications including even lethal outcome. Finally, it can be concluded that it is of great importance to identify the best possible treatment and preventive regimens in order to enable continuity of the antituberculosis therapy to the full extent.

An analysis of serious adverse drug reactions at a tertiary care teaching hospital

“…This also substantiates our findings that anti-tubercular and antiretroviral drugs are known to cause skin reactions and liver damage. [181920] Probably, this supports cohort monitoring and integration of Revised National Tuberculosis Control Programme and ART programme with nationwide PvPI. In addition, it has been reported by Agaard et al .…”

Severe antiretroviral‐associated skin reactions in South African patients: a case series and case–control analysis

“…Our data suggest that antitubercular treatment may increase risk of severe skin reactions in patients on cART, but we did not have sufficient power to confirm this association. Drugs used in antitubercular therapy can cause severe skin reactions . TB is often the illness that leads to presentation at a healthcare facility, subsequently leading to testing for HIV, hence initiation of cART and antitubercular therapy at the same time, usually with low CD4 counts.…”

“…Drugs used in antitubercular therapy can cause severe skin reactions. [51][52][53] TB is often the illness that leads to presentation at a healthcare facility, subsequently leading to testing for HIV, hence initiation of cART and antitubercular therapy at the same time, usually with low CD4 counts. Co-trimoxazole, a common cause of severe cutaneous adverse reaction, for pneumocystis jeroveci prophylaxis is often also initiated at the same time.…”

Mixed lichenoid and psoriasiform drug eruption induced by rifampicin

“…Cutaneous adverse drug reaction is one of the most common type of adverse reactions associated with anti‐tuberculosis therapy ,. These reactions typically occur within 2 months of treatment initiation . The common drug reactions caused by rifampicin include morbilliform rash, erythema multiforme and urticaria, and maculopapular exanthema .…”