Side-effects are unwanted symptoms, discomfort or more serious adverse (harmful) consequences of drug treatment. Serious side-effects are rare in patients taking anti-TB drugs. A minority of TB patients treated with Category I or Category II regimens experience adverse side-effects categorised as:

major adverse side-effects giving rise to serious health concerns that require the stopping of anti-TB treatment
minor side-effects causing relatively little discomfort and often responding to simple treatment of the symptoms; they may occasionally persist for the whole period of anti-TB treatment.

Possible side-effects of the anti-TB drugs and their management are listed in Table 14.6.

Table 14.6 Symptom-based approach to management of anti-TB drug side-effects

Side-effects		Drugs	Management
(a) Minor (continue anti-TB drugs)	Decreased appetite, nausea, abdominal pain	rifampicin pyrazinamide	Give tablets with small meals or last thing at night
	Joint pains	pyrazinamide	Aspirin
	Burning sensation in the feet	isoniazid	Pyridoxine 100 mg daily
	Orange/red urine	rifampicin	Reassurance; symptom is harmless
	Itching, skin rash	streptomycin; rifampicin or isoniazid	Refer to higher health facility where TB treatment is available
(b) Major (stop the drug(s) responsible)	Deafness	streptomycin	Refer to higher health facility where TB treatment is available
	Dizziness (vertigo, imbalance and loss of balance)	streptomycin	Refer to higher health facility where TB treatment is available
	Yellowish discoloration of the eye (hepatitis)	most anti-TB drugs	Refer to higher health facility where TB treatment is available
	Vomiting and confusion	most anti-TB drugs	Refer to higher health facility where TB treatment is available
	Visual impairment	ethambutol	Refer to higher health facility where TB treatment is available
	Shock, skin rash and decreased urine output	rifampicin	Refer to higher health facility where TB treatment is available

In the next study session we turn to the subject of following-up patients and tracing patients who are not taking their medication.