A SYSTEMATIC REVIEW ON ADVERSE EFFECTS OF ANTI-TUBERCULAR DRUGS
Abstract
The treatment of tuberculosis (TB) relies heavily on a multidrug regimen, which, while effective, often comes with a range of adverse effects that can compromise patient adherence and treatment success. This systematic review aims to comprehensively assess the adverse effects associated with first-line and second-line anti-tubercular drugs.
We searched PubMed, Scopus, and Cochrane Library databases for studies published between January 2000 and December 2023, focusing on the prevalence, nature, and severity of adverse effects in patients undergoing TB treatment.
The review includes randomized controlled trials, cohort studies, and case series involving adults and children treated for both drug-susceptible and drug-resistant TB. Data were extracted on the incidence of hepatotoxicity, gastrointestinal disturbances, neurotoxicity, dermatological reactions, and other significant adverse effects. The quality of included studies was assessed using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale.
Our findings indicate that hepatotoxicity is the most common severe adverse effect, particularly associated with isoniazid, rifampicin, and pyrazinamide, leading to treatment modification in a significant proportion of patients. Gastrointestinal disturbances, such as nausea and vomiting, are frequently reported with ethambutol and rifampicin.
Neurotoxic effects, including peripheral neuropathy and central nervous system toxicity, are mainly linked to isoniazid and ethionamide. Dermatological reactions, ranging from mild rash to severe cutaneous adverse reactions, are notably observed with rifampicin.
Second-line drugs, used primarily for multidrug-resistant TB, present a higher risk profile, with linezolid and aminoglycosides contributing to significant ototoxicity and nephrotoxicity. The review also highlights the impact of these adverse effects on treatment adherence and outcomes, emphasizing the need for regular monitoring and management strategies to mitigate these risks.
In conclusion, while anti-tubercular drugs are essential for TB control, their adverse effects pose substantial challenges. This review underscores the importance of personalized treatment approaches and the development of new therapeutic agents with improved safety profiles to enhance patient adherence and treatment efficacy.
Future research should focus on identifying genetic and demographic predictors of adverse effects to better tailor TB therapy. This abstract summarizes the key findings and implications of the systematic review, providing a clear overview for researchers, healthcare professionals, and policymakers interested in the adverse effects of anti-tubercular drugs.
