Adverse reactions to first-line antituberculosis drugs.
BACKGROUND
Tuberculosis continues to be a major cause of morbidity and mortality worldwide. Currently available drugs are effective for treatment of the disease or latent infection, but may cause serious adverse effects.


METHODS
The authors reviewed the literature for side effects of five first-line antituberculous medications (isoniazid, rifampin, pyrazinamide, ethambutol and streptomycin). Incidence of the major side effects were compiled with particular attention to the incidence of isoniazid hepatotoxicity.


RESULTS
Hepatotoxicity to isoniazid is a serious problem. Although overall incidence may be decreasing, incidence averaged 9.2 per 1000 patients who were compliant, in multiple studies, with a case fatality rate of 4.7%. The incidence is higher with increasing age. Other serious adverse effects include dermatological, gastrointestinal, hypersensitivity, neurological, haematological and renal reactions. They can lead to drug discontinuation (in up to 10% of patients) or even more serious morbidity or mortality.


CONCLUSIONS
Side effects to antituberculosis drugs are common, and include hepatitis, cutaneous reactions, gastrointestinal intolerance, haematological reactions and renal failure. These adverse effects must be recognised early, to reduce associated morbidity and mortality.
Forget
Eric J
EJ
Respiratory Epidemiology Unit, Montreal Chest Institute, McGill University, Montréal, Québec, H2X 2P4, Canada.
Menzies
Dick
D
D000367:Age Factors; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000503:physiopathology*; D004342:Drug Hypersensitivity; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D015994:Incidence; D009017:Morbidity; D051437:Renal Insufficiency / Q000139:chemically induced; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy
D000995:Antitubercular Agents