Content Status
Type
Linked Node
Management of DR-TB ADR: Gastritis, abdominal pain
Learning ObjectivesManagement of DR-TB ADR: Gastrointestinal Symptoms [Gastritis and abdominal pain
H5Content
Content
Adverse Drug Reactions (ADRs), such as gastritis and abdominal pain, may occur from the Drug-resistant TB (DR-TB) treatment regimen.
Suspected agent(s): Para Aminosalicylic Acid (PAS), Ethionamide (Eto), Clofazimine (Cfz), Linezolid (Lzd), Fluoroquinolone (FQs), Isoniazid (H), Ethambutol (E), and Pyrazinamide (Z)
- Abdominal pain is often associated with serious adverse effects, such as pancreatitis {Lzd, Bedaquiline (Bdq)}, lactic acidosis and hepatitis.
- If any of these are suspected, it is important to obtain appropriate laboratory tests to confirm and suspend the suspected agent.
Suggested Management Strategies
- For gastritis-like symptoms (epigastric burning or discomfort, sour taste in mouth associated with reflux) initiate medical treatment with the use of H2-blockers (Ranitidine 150 mg twice daily or 300 mg once daily).
- Proton-pump inhibitors (Omeprazole 20 mg once daily) should be avoided along with Bdq.
- Avoid use of antacids as they decrease absorption of FQ.
- For severe abdominal pain, stop suspected agent(s) for short periods of time (1-7 days).
- Lower the dose of the suspected agent or discontinue, if this can be done without compromising the regimen.
Points to Note
- Severe gastritis, as manifested by blood in the vomit or stool, is relatively rare but should always be treated to facilitate adherence to treatment.
- If antacids must be used, they should be carefully timed to not interfere with absorption of FQ (take two hours before or three hours after anti-TB drugs).
- Stop any non-steroidal anti-inflammatory drugs the patient may be taking.
- Diagnose and treat Helicobacter pylori infections.
- Severe abdominal distress has been reported with the use of Cfz. Although these reports are rare, if this occurs, Cfz should be suspended.
Resources
- Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
- Ready Reckoner for Medical Officer- Adverse Drug Reactions Associated with Anti-TB Drugs Identification and Management, 2019.
- Technical and Operational Guidelines for TB in India, 2016.
Kindly provide your valuable feedback on the page to the link provided HERE
LMS Page Link
Content Creator
Reviewer
Target Audience
- Log in to post comments