Adverse Drug Reactions in the Treatment of Drug-Resistant Tuberculosis: A Narrative Review

Abstract

Drug-resistant tuberculosis (DR TB), which includes ‘multidrug-resistant TB’ (MDR TB) and ‘extensively drug-resistant TB’ (XDR TB), is a significant global health challenge. The treatment response and outcomes are even more challenging in regions with high poverty, malnutrition, and high rates of HIV co-infection. Despite advancements in treatment regimens, ‘adverse drug reactions’ (ADRs) are still a critical barrier to treatment success, contributing to non-compliance, regimen modifications, and treatment failure. This review investigates the occurrence, severity, and types of ADRs related to DR-TB treatment, highlighting their impact on patient outcomes. Specific ADRs linked to commonly used second-line anti-TB drugs include peripheral neuropathy, anaemia, and optic neuritis with linezolid; tendinitis with fluoroquinolones; QT prolongation and hepatotoxicity with bedaquiline; skin discoloration with clofazimine; psychiatric disorders and seizures with cycloserine; hypothyroidism, gynecomastia, and gastrointestinal side effects with ethionamide; nephrotoxicity and vestibular toxicity with amikacin/kanamycin; and hypothyroidism and hepatitis with para-amino salicylic acid (PAS).
The complexity, cost, and duration of current treatment regimens exacerbate these challenges, undermining the WHO’s target of an 80% treatment success rate. Enhanced pharmacovigilance, patient-centered care, and tailored regimens are crucial to managing ADRs and ensuring adherence to therapy. Developing safer therapies and effective mitigation strategies is crucial for enhancing treatment outcomes for DR-TB and advancing global initiatives to control and eradicate tuberculosis.