title: Outcomes of reintroducing anti-tuberculosis drugs following cutaneous adverse drug reactions.
abstract: BACKGROUND
  Data regarding outcomes of tuberculosis (TB) associated cutaneous adverse drug reactions (CADR) are limited. The re-introduction of first-line anti-tuberculosis drugs after CADR is controversial and management poorly defined.
  
  
  METHODS
  We retrospectively reviewed the records of 298 patients with CADR admitted to a tertiary dermatology ward in Cape Town, South Africa.
  
  
  RESULTS
  TB-associated CADR was diagnosed in 65 of 298 patients. Of these, 60/65 (92%) were human immunodeficiency virus (HIV) infected (median CD4 count 107 cells/mm (3)). Anti-tuberculosis drugs were reintroduced in 46/65 (71%) patients, of whom 23/46 (50%) developed re-introduction reactions. The most frequent re-introduction reactions were itch in 11/23 (48%) and hepatitis in 9/23 (39%) patients. Of the 23 re-introduction reactions, 13 (57%) were mild, six (26%) moderate and four (26%) severe. Among those with reintroduction reactions, rifampicin (RMP) was the offending drug in 13/23 (57%), isoniazid in 5/23(22%), pyrazinamide in 3/23 (13%), and ethambutol, streptomycin and ofloxacin each in 1/23 (4%) cases. Lack of previous TB treatment and re-challenge with RMP were independently associated with the likelihood of reintroduction reactions.
  
  
  CONCLUSIONS
  In this high TB burden setting, although re-introduction reactions are common, the majority are non-life-threatening. All first-line anti-tuberculosis drugs can cause CADR, and RMP is more commonly implicated than previously reported. These data guide the management of anti-tuberculosis drug-associated CADR in high HIV prevalence settings.
authors: Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
authors: R J
authors: RJ
authors: Lehloenya
authors: G
authors: G
authors: Todd
authors: M
authors: M
authors: Badri
authors: K
authors: K
authors: Dheda
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003875:Drug Eruptions / Q000209:etiology* / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology; D014376:Tuberculosis / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents