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Adverse Drug Reactions (ADRs), such as diarrhoea and/or flatulence, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

 

Suspected agent(s): Para Aminosalicylic Acid (PAS), Ethionamide (Eto)

 

Suggested Management Strategies

 

  • Motivate patients to tolerate some degree of loose stools and flatulence.
  • Encourage fluid intake.
  • Treat uncomplicated diarrhoea (no blood in stool and no fever) with Cap Racecadotril 1 stat followed after 8 hours.
  • Check serum electrolytes (especially potassium) and dehydration status if diarrhoea is severe.
  • Fever and diarrhoea and/or blood in the stools indicate that diarrhoea may be secondary to something other than a simple adverse effect of anti-TB drugs.

 

Points to Note

 

  • Consider other causes of diarrhoea, such as:
    • Pseudo-membranous colitis: It is related to broad-spectrum antibiotics (such as FQ), is a serious and even life-threatening condition, and shows warning signs such as fever, bloody diarrhoea, intense abdominal pain and increased white blood cells.
    • Parasites and common waterborne pathogens in the area of the patient: Evaluate and treat these.
    • Lactose intolerance: Especially if the patient has been exposed to new foods in the hospital which is not normally part of his/ her diet.
  • Consider using Loperamide in children over two years of age.

 

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