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Cutaneous Adverse Drug Reactions from Antituberculosis Treatment

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Advances in Diagnosis and Management of Cutaneous Adverse Drug Reactions

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Abstract

Effective treatment for drug-sensitive TB remains a long, multidrug endeavor. Therapeutic complexity is increased by HIV coinfection (>60% of incident TB cases are co-infected in HIV/TB endemic settings) and the growing burden of multi- and extremely drug-resistant TB (MDR- and XDR-TB). CADRs are common adverse reactions in both drug-sensitive and resistant anti-TB regimens, and the majorities are delayed T-cell-mediated reactions. Individual anti-TB drugs cause different CADR phenotypes of varying severity, while SCAR phenotypes such as DRESS, SJS/TEN, and LDE have been associated with many chemically different anti-TB drugs. The key management challenges include (1) multiple possible offending drugs, with a lack of accurate diagnostic testing, (2) high TB-related mortality with prolonged treatment interruptions, and (3) not unnecessarily excluding effective non-culprit anti-TB drugs in CADR patients. We discuss the spectrum of anti-TB drug-associated CADRs and offending drugs, as well as the pragmatic utility of drug provocation testing to identify culprit drugs and minimize treatment interruptions.

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Abbreviations

ADRs:

Adverse drug reactions

AGEP:

Acute generalized exanthematous pustolosis

DPT:

Drug provocation testing

DRESS:

Drug rash with eosinophilia and systemic symptoms

DS-TB:

Drug-susceptible TB

FDE:

Fixed drug eruption

FQ:

Fluoroquinolones

HAART:

Highly active antiretroviral therapy

LDE:

Lichenoid drug eruption

MDR-TB:

Multidrug-resistant TB

SCAR:

Severe cutaneous adverse drug reaction

SJS/TEN:

Stevens-Johnson syndrome and toxic epidermal necrolysis

TB:

Tuberculosis

XDR-TB:

Extensively drug-resistant TB

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Author information

Authors and Affiliations

  1. Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa

    Jonny Peter

  2. Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa

    Jonny Peter

  3. Division of Dermatology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

    Rannakoe J. Lehloenya

Authors
  1. Jonny Peter
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  2. Rannakoe J. Lehloenya
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Corresponding author

Correspondence to Jonny Peter .

Editor information

Editors and Affiliations

  1. University of Toronto Medical School, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Neil H. Shear

  2. Department of Dermatology, Emek Medical Center, Afula, Israel

    Roni P. Dodiuk-Gad

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Peter, J., Lehloenya, R.J. (2019). Cutaneous Adverse Drug Reactions from Antituberculosis Treatment. In: Shear, N., Dodiuk-Gad, R. (eds) Advances in Diagnosis and Management of Cutaneous Adverse Drug Reactions. Adis, Singapore. https://doi.org/10.1007/978-981-13-1489-6_14

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  • DOI: https://doi.org/10.1007/978-981-13-1489-6_14

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  • Publisher Name: Adis, Singapore

  • Print ISBN: 978-981-13-1488-9

  • Online ISBN: 978-981-13-1489-6

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