Table 6 summarizes the incidence of the most common adverse events associated with the medications used to treat MDR-TB, as well as the recommended monitoring. Table 7 describes important drug interactions to consider when prescribing MDR-TB treatment.
Most patients experience side effects to at least 1 drug used to treat MDR-TB. Patients should be educated about adverse effects, and clinicians should attempt to investigate and treat all adverse effects quickly. Some adverse effects are difficult to tolerate but do not pose any risk of organ damage (eg, nausea and vomiting without evidence of hepatotoxicity); attempts should be made to manage these symptoms with supportive care and ancillary medication, before discontinuing the culprit anti-TB medication. Other adverse effects do put patients at risk for serious organ damage and necessitate discontinuing the culprit medication in a timely manner. When an anti-TB drug is discontinued due to adverse effects, that medication should be replaced by another drug used for the treatment of MDR-TB, in order to continue with the recommended number of effective drugs in the regimen. However, the strength of the regimen should be kept in mind; if many of the drugs in the preferred initial regimen (ie, moxifloxacin/levofloxacin, bedaquiline, linezolid, cycloserine, clofazimine) cannot be used or are discontinued because of adverse events, clinicians should consider using more than 5 drugs in the intensive phase and/or extending the treatment duration beyond 18 months. See the WHO Operational Handbook for examples of regimens that can be used in these circumstances.93
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