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Grades of Severity

  • Mild - Mild nausea & vomiting, Without any symptoms of dehydration
  • Moderate - Slightly more nausea & vomiting, with symptoms of mild dehydration (increased thirst, dry tongue, mouth, etc.) and generalised weakness
  • Severe - Excessive vomiting,  Weakness and inability to stand, Sunken eyes with loss of skin elasticity and Electrolyte imbalance
  • Potentially Life-Threatening - All symptoms of ‘severe category’, blood in vomit with a decrease in Urination, Altered level of consciousness

Possible Offending Medications

Isoniazid (H), Rifampicin (R), Pyrazinamide (Z) Ethionamide (Eto), Streptomycin (S), Prothionamide (Pto), P-aminosalicylic Acid (PAS), Clofazimine (Cfz), Bedaquline (Bdq)

Level of Management

Health Worker Level (Treatment supporter, ASHA, Community member)

  • Counsel patients & reassure them that these symptoms resolve with time
  • Remind patients -
  • To do not take all the drugs together
  • To take the drugs with little water
  • To take the drugs embedded in banana or with milk or at bedtime
  • To take a light meal (biscuits, bread, rice) before consuming the drugs

 

Sub Center Level (CHO, ANM & MPHW)

  • Monitor and ensure hydration
  • Give oral rehydration solution (ORS)
  • Give domperidone/ omeprazole/ ranitidine metoclopramide 30 min before the patient consumes anti-TB drugs

 

Health Institutes Level (PHC, CHC, Hospitals)

  • Give ondansetron* 30 min before the patient takes anti-tb drugs (Avoid ondansetron in patients who are on BDQ/DLM)
  • Assess for danger signs (dehydration, electrolyte imbalance, hepatitis)
  • Initiate rehydration therapy (intravenous) & replace electrolytes if required
  • Divide/reduce the dose of offending/anti-tb drugs without compromising on the regimen
  • If nausea & vomiting are anticipated, give a small dose of an anti-anxiety drug (5 mg diazepam) 30 min before drug intake
  • Refer in case of Persists vomiting, blood in vomiting, Moderate to severe dehydration 

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