Clinical aspects of TB

Treatment

Treatment programmes

Anti TB drugs

Drug hypersensitivity and desensitization :.

Hypersensitivity reactions can occur to any drug. Fever and skin rash are by far the most common manifestations. It may present in severe forms such as exfoliative dermatitis or Steven-Johnson Syndrome. Sometimes the lymph nodes may be enlarged and hepatitis may occur with or without jaundice.

The majority of hypersensitivity reactions occur during the first 6 weeks of treatment. If a patient develops a fever during this period, drug hypersensitivity should be considered.

Management of drug hypersensitivity :.

The principles of managing a reaction are -

1. Stop all chemotherapy until the reaction has subsided and consider use of anti-histamines or topical steroids.

2. Identify the drug or drugs responsible for the reaction if possible.

3. Continuing treatment with other non-sensitizing TB drugs, "desensitize"* the patient to the drug or drugs responsible for the reaction; this will prevent a resistant strain from emerging. This may not be possible in some instances where a severe reaction has occurred.

4. Resume an adequate regimen as soon as possible.

Procedure for "desensitization" - Confirm hypersensitivity to one or more drugs by giving a test (small) dose of each individual drug. If no reaction occurs, the test dose is gradually increased to the full daily dose. When the full daily dose is reached, continue giving that drug, without any further interruption, while the other drugs are being tested similarly.

* The term "desensitize" here refers to systematically rechallenge the patient with likely sensitizing drug in order to establish the offending agent. This is different from formal desensitization.

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