Management of DR-TB ADR: Suicidal Ideation

Adverse Drug Reaction (ADR), such as suicidal ideation, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

​​Suspected agent(s): Cycloserine (Cs), Isoniazid (H), Ethionamide (Eto)

Suggested Management Strategies

• Hospitalize the patient and put them under 24-hour surveillance.
• Discontinue Cs.
• Request psychiatric consultation. 
• Initiate antidepressant treatment.
• Lower the dose of Eto until the patient is stable.

Points to Note

• Keep the patient in the hospital until the risk of suicide has passed.
• If no improvement occurs after withholding Cs, withhold H and/or Eto.

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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