Management of adverse reactions to first-line tuberculosis antibiotics

Nagarajan, Sowmya; Whitaker, Paul

doi:10.1097/aci.0000000000000462

Cited by 29 publications

(34 citation statements)

References 69 publications

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“…IM-ADRs to the first-line antituberculosis drugs (FLTDs) -rifampicin, isoniazid, pyrazinamide and ethambutol, are the commonest given the high prevalence of comorbid TB in HIV endemic settings. A full spectrum of particularly delayed hypersensitivity reactions to FLTDs and second-line anti-TB drugs is listed in Table 1 and has recently been comprehensively reviewed [22]. Isoniazid, rifampicin and pyrazinamide are the commonest offending agents for both SCAR and drug-induced liver injury (DILI) [22].…”

Section: Epidemiology Of Drug Hypersensitivity: An Evolving Landscapementioning

confidence: 99%

“…A full spectrum of particularly delayed hypersensitivity reactions to FLTDs and second-line anti-TB drugs is listed in Table 1 and has recently been comprehensively reviewed [22]. Isoniazid, rifampicin and pyrazinamide are the commonest offending agents for both SCAR and drug-induced liver injury (DILI) [22]. A recent cohort of 307 Thai adults with HIV/TB co-infection reported CADRs as the commonest IM-ADRs, occurring at an incidence rate of 0.41 events/person-year [23].…”

Section: Epidemiology Of Drug Hypersensitivity: An Evolving Landscapementioning

confidence: 99%

“…Liver toxicity and DILI is a common ADR in HIV-infected patients. HIV-infected patients have multiple causes and risk factors for both liver enzyme abnormalities and immunemediated DILI including comorbid infections; alcoholism; nutritional abnormalities; and the need for multiple drugs, many metabolized through the liver and with induction/inhibition effects on cytochrome p450 enzyme systems, and/or other complex interactions [22,67]. In the majority of instances, DILI patterns are similar in HIV-infected versus uninfected patients, for example, anti-TB drugs; incidence, however, is dramatically increased, with patients on HAART having a 10-fold increased risk of anti-TB drug DILI [68].…”

Section: Spectrum Clinical Presentations and Outcomesmentioning

confidence: 99%

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Drug hypersensitivity in HIV infection

Peter

Choshi

Lehloenya

2019

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review-Immune-mediated adverse drug reactions (IM-ADRs) are many times more common in HIV-infected patients. Usual offending drugs include antiretroviral and antiinfectives, but the burden of specific drug IM-ADRs is population-specific; changing as new and fixed dose combinations enter the market, and drug-resistance patterns demand. This review considers recent literature on epidemiology, mechanisms, clinical management and prevention of IM-ADRs amongst persons living with HIV/AIDS. Recent findings-Epidemiological studies continue to describe high rates of delayed hypersensitivity to known offenders, as well as similar reactions in preexposure prophylaxis. IM-ADRs to oral and injectable integrase strand transfer inhibitors are reported with expanding use. The clinical spectrum and management of IM-ADRs occurring in HIV-infected populations is similar to uninfected; with exceptions such as a recently described severe delayed efavirenz DILI with high mortality. Furthermore, the context can be unique, such as the lower than expected mortality in a Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) cohort from a HIV/TB high burden setting. Programmatic data showing the near complete elimination of Abacavir drug hypersensitivity syndrome following implementation of HLA-B57:01 screening is a stellar example of how prevention is possible with mechanistic insight. Summary-IM-ADRs remain a challenge in persons living with HIV. The complexities posed by polypharmacy, overlapping drug toxicities, drug interactions, overlap of IM-ADRs with other diseases, limited alternative drugs, and vulnerable patients with advanced immunosuppression with high mortality, necessitate increased use of drug provocation testing, treat-through and desensitization strategies. There is an urgent need for improved diagnostics and predictive biomarkers for prevention, or to guide treat-through, rechallenge and desensitization approaches.

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Section: Epidemiology Of Drug Hypersensitivity: An Evolving Landscapementioning

confidence: 99%

Section: Epidemiology Of Drug Hypersensitivity: An Evolving Landscapementioning

confidence: 99%

Section: Spectrum Clinical Presentations and Outcomesmentioning

confidence: 99%

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Drug hypersensitivity in HIV infection

Peter

Choshi

Lehloenya

2019

Current Opinion in Allergy &Amp; Clinical Immunology

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“…As the cutaneous reaction was only moderate, the patient did not stop his anti‐tuberculosis medication. Guidelines indicate that if the cutaneous adverse drug reaction is not serious, anti‐tuberculosis drugs can continue to be used under close clinical monitoring, and antihistamines along with topical corticosteroids can be administered …”

Section: Main Textmentioning

confidence: 99%

Mixed lichenoid and psoriasiform drug eruption induced by rifampicin

Feng

et al. 2019

Aust J Dermatology

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“…Entre los efectos adversos más importantes se encuentran la hepatotoxicidad por isoniazida, rifampicina y pirazinamida (12) , alteración del intervalo QT en el electrocardiograma por quinolonas (13) , mielosupresión por linezolid (14) y nefrotoxicidad, ototoxicidad y alteraciones electrolíticas por aminoglucósidos inyectables (15) . Por ello, el manejo y seguimiento deben ser siempre acompañados de exámenes que permitan valorar la posibilidad de que se esté presentando efectos adversos.…”

Section: Referencias Bibliográficasunclassified

Tuberculosis congénita pre-extensivamente resistente a drogas: reporte de caso

Castillo

Lopez

Temoche

et al. 2018

Rev Peru Med Exp Salud Publica

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RESUMENLa tuberculosis en el lactante es un cuadro de difícil diagnóstico por las pruebas diagnósticas que muchas veces resultan negativas y por la dificultad de identificar la fuente de transmisión. Se presenta el caso de un lactante varón de un mes de vida que presenta irritabilidad, taquipnea, fiebre, pobre ganancia de peso desde el nacimiento y hepatomegalia, además, tiene el antecedente materno de tuberculosis pre-extensivamente resistente a drogas y reacción granulomatosa tuberculoide con tinción auramina positiva para bacilos ácido-alcohol resistentes en la histopatología de placenta. Ante la sospecha de tuberculosis congénita, es referido al Instituto Nacional de Salud del Niño para estudio diagnóstico y tratamiento; el paciente presenta una evolución clínica favorable y sin reacciones adversas al tratamiento. El diagnóstico de tuberculosis congénita debe considerarse en lactantes con signos clínicos sugestivos de la enfermedad y mantener la sospecha ante la presencia del antecedente materno de infección por Mycobacterium tuberculosis. ABSTRACTTuberculosis in infants is a clinical case difficult to diagnose by regular testing which often yield negative results; additionally, the source of transmission is difficult to identify. This work presents the case of a one-month old nursing boy presenting irritability, tachypnea, fever, poor gain weight from birth, and hepatomegaly. Additionally, he had the maternal history of pre-extensively drug-resistant tuberculosis and tuberculoid granulomatosis reaction with positive auramine tincture for acid-alcohol resistant bacilli at histopathology of the placenta. With a suspected congenital tuberculosis, he was referred to the National Children's Health Institute for diagnosis and treatment. The patient showed a favorable clinical evolution and no adverse reactions to treatment. The diagnosis of congenital tuberculosis must be considered in infants with suggestive clinical signs of the disease and such suspicion must be maintained with the presence of a maternal history of Mycobacterium tuberculosis infection.

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Management of adverse reactions to first-line tuberculosis antibiotics

Cited by 29 publications

References 69 publications

Drug hypersensitivity in HIV infection

Drug hypersensitivity in HIV infection

Mixed lichenoid and psoriasiform drug eruption induced by rifampicin

Tuberculosis congénita pre-extensivamente resistente a drogas: reporte de caso

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