Management of DR-TB ADR: Diarrhoea and/or Flatulence

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.

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.

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