I. Rifampicin
1, liver damage: similar to the liver damage that occurs with INH, generally can continue to take; if jaundice, hepatic necrosis or combined with allergic reactions, then the drug should be discontinued.
2. Gastrointestinal reactions: anorexia, nausea, vomiting, abdominal pain, diarrhea. Generally, symptomatic treatment can be given.
3, allergic reactions: including anaphylaxis, flu-like syndrome (fever, flu-like symptoms), respiratory syndrome (episodes of dyspnea, shortness of breath), skin syndrome (simple pruritus in mild cases, rash or even exfoliative dermatitis in severe cases). These syndromes can occur alone or in combination, mostly when RFP is administered intermittently. After the diagnosis is clear, immediately stop the drug and related treatment.
4. Hematological abnormalities: thrombocytopenic purpura, hemolytic anemia, leukopenia, eosinophilia.
Other: rare adverse reactions include osteochondrosis, joint swelling, increased blood pressure, cardiac arrhythmia, hair loss, renal failure in severe cases, shock (decreased blood pressure, deficiency), and may have teratogenic effects on fetal development (especially in the first 3 months of early pregnancy).
Other rifampicin, such as rifadin, rifapentine and rifabutin, have similar adverse effects to RFP, but they are less frequent and milder than RFP.
Second, isoniazid
1, adverse reactions of the nervous system: the most common peripheral neuritis, initially manifested as symmetrical sensory abnormalities in the left and right hands and feet, followed by numbness, tingling, burning sensation at the end of the fingers and toes, weakness of the limbs, joint weakness and slow reaction. The mechanism is that isoniazid and vitamin B6 are similar in structure, and they compete for the same enzyme system (such as Apo tryptase) or their combination increases excretion from urine, resulting in vitamin B6 deficiency in the body and clinical manifestations of vitamin B6 deficiency. Those who take large doses of isoniazid, the elderly, patients with chronic liver disease, rapid acetylation of INH in the body (slow acetylation occurs more in medium and large doses) and malnutrition, alcoholism, pregnancy and other factors are susceptible to neuritis. When the dosage of isoniazid is large, vitamin B6 can be added for prevention, 0.03g-0.1g/day, but because vitamin B6 can reduce the However, because vitamin B6 can reduce the antibacterial power of isoniazid in the test tube, the general dose is not used as regular medication.
In addition, a variety of psychiatric abnormalities may occur, such as excitement, restlessness, insomnia, inattention, memory loss, depression, vertigo, headache, drowsiness, dreaminess, delusions, hallucinations, and even psychosis; a few may have optic neuritis, optic nerve atrophy, hyperreflexia, and muscle tremor. The effects on the central nervous system may be due to the inhibition of monoamine oxidase activity in the body by isoniazid, causing the accumulation of histamine in the body and the above reactions. Other reactions include induced seizures, central encephalopathy, toxic psychosis, etc. Those with a history of epilepsy or psychosis may lead to seizures.
2. Liver damage: It usually occurs 3 days-3 months after treatment, and is often simple, transient and reversible transaminase elevation, usually without clinical significance, and transaminase can drop rapidly after stopping the drug. It is generally believed that the liver damage from isoniazid is due to individual specificity causing aggregation of isoniazid toxic metabolites. About 10-20% of patients on isoniazid prophylaxis alone develop transient transaminase elevation, mostly without conscious symptoms. Severe liver damage occurs in about 1.25% of patients, and there are even cases of death. Most cases of liver damage appear within 6 months of drug administration. Liver damage is age-related (the older the patient is, the more likely it is to occur) and is rare in patients under 20 years of age; those with chronic liver disease are also more likely to develop liver function damage. Isoniazid can increase the toxicity to the liver when combined with rifampin. When liver damage occurs after applying isoniazid, first stop the drug and add appropriate liver-protective drugs if necessary, but do not use too many kinds of liver-protective drugs at the same time, so as not to further increase the burden on the liver.
3, endocrine disorders: male breast enlargement, impotence, female menstrual disorders, Cushing’s syndrome.
4, blood system: leukopenia, eosinophilia, hemolytic anemia, hemorrhagic purpura, aplastic anemia.
5, allergic reactions: rash, drug fever, etc.
6, gastrointestinal reactions: nausea, vomiting, diarrhea, constipation, etc.
7, other: urinary difficulties, cardiac arrhythmia, etc.
If the above 3-7 side reactions occur, continue the treatment and observation temporarily if the symptoms are mild, and reduce the application of isoniazid or discontinue it if it is serious.
Pyrazinamide
PZA was only used cautiously as a second-line drug in the past due to its large dosage, long treatment course and high hepatotoxicity. Recent studies have proven that PZA is an intracellular bactericidal agent, especially in the acidic environment within macrophages, and has a strong sterilizing effect (also known as a semi-bactericidal agent). The sterilizing effect is higher in the first two months when the lesion is in the stage of acute inflammatory changes. Therefore, the application of PZA not only shortens the course of treatment, but also reduces the recurrence rate. Its adverse reactions are.
1, gastrointestinal reactions: mainly manifested as nausea, vomiting, loss of appetite.
2, liver damage: related to the dose and course of treatment. At the current conventional dose (1500-2000mg/day) and the course of treatment (generally 2 months), liver damage is rarely seen.
3.Arthralgia: mainly arthralgia and joint swelling caused by the increase of uric acid concentration in blood, and even joint ankylosis and limitation of movement.
4, other: rare adverse reactions include allergic reactions (fever, rash), skin photosensitization (bright red-brown or bronze color on exposed parts of the skin), and rarely lead to hypochromic anemia with hemolytic reactions, ulcerative episodes, difficulty in urination.
IV. Streptomycin
SM has a strong bactericidal effect on rapidly proliferating bacteria in the alkaline environment outside macrophages (so called semi-bactericidal drug), can pass well through the plasma membrane cavity, but rarely through the normal blood-brain barrier, and can enter the fetal circulation through the placenta. Its adverse effects are.
1, vestibular nerve damage: common in the first two months of drug use, can appear vertigo (stop or reduce the dose can disappear), dyskinesia (so that the patient closed eyes walking along a straight line, its stability is not as good as when the eyes are open), vomiting and other symptoms. Older patients are more likely to experience these adverse effects.
2. Eighth to cranial (cochlear) nerve damage: tinnitus, hearing loss, deafness (permanent in severe cases).
3.Allergic reactions: most of them are numbness around the mouth, nausea, vomiting, fever. Itching and various rashes such as papules, erythema, urticaria, herpes, measles or scarlet fever-like rash, eczema, exfoliative dermatitis may appear on the skin. Anaphylaxis (sudden onset of dyspnea, pallor, cyanosis, convulsions, foaming at the mouth, incontinence of urine and stool within 10 minutes of injection).
4.Renal damage: urine protein, tubular pattern, hematuria, acute renal failure.
5, bone marrow suppression: leukopenia, thrombocytopenic purpura, aplastic anemia.
6, Other: rare adverse reactions include drug fever, etc.
V. Ethambutol
EMB is a synthetic drug, effective against Mycobacterium tuberculosis and other branching bacteria (such as Mycobacterium kansasii), but not against other microorganisms and mycobacteria. It is easily absorbed orally, and its effect is mainly to inhibit the growth of tubercle bacilli and is used to prevent resistance to major bactericidal drugs. Its adverse effects are.
1, optic neuritis: visual fatigue, progressive vision loss, and even blindness due to retrobulbar optic neuritis, with dose-related toxic reactions (dose-dependent optic neuritis). Occasionally, peripheral neuritis of the legs occurs.
2, allergic reactions: fever, rash, exfoliative dermatitis, thrombocytopenic purpura, asthma, shock.
3.Other: hypocalcemia, peripheral nerve disorder (mainly in the legs), mouth and lip ulcers, rhinorrhea, loss of voice due to vocal cord paralysis.
VI. Quinolones
Including ofloxacin, levofloxacin, ciprofloxacin, sparfloxacin, etc. These drugs have bactericidal or antibacterial effects on Gram-positive or negative bacteria, Mycobacterium tuberculosis or non-tuberculous branching bacteria, and the concentration in macrophages is higher than the blood concentration; not only no cross-resistance with other tuberculosis drugs, but also synergistic effects. Currently, it is used as a second-line drug to treat drug-resistant cases with certain effect. Its adverse reactions are mainly manifested as follows
1, gastrointestinal reactions: symptoms include anorexia, nausea, vomiting, epigastric discomfort, diarrhea, etc.
2, central nervous system symptoms: vertigo, headache, mood changes, rare convulsions.
3.Liver function abnormalities: a few cases showed elevated transaminases, mostly transient.
4.Individual patients appear allergic reaction fever, rash.
5.Hindrance to the growth and development of bones and cartilage, individual reports of CFX have caused tendon damage.
6.Cardiac arrhythmia: Sulforaphane may cause prolongation of Q-T interval.
7.Other: There may be hematuria, hemophagocytosis, leukopenia, etc.