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Evidence for clinical use relies on case reports; expensive.

*LFTs: Liver function tests. ** CNS: Central nervous system.

*LFTs: Liver function tests. ** CNS: Central nervous system.

Ciprofloxacin

Also available for i.v. injection

Patients who exhibit severe side effects should always be hospitalized for diagnosis and treatment. Drugs that could possibly be responsible for a given side effect are stopped. Reintroduction of the same drug must be avoided if visual dysfunction occurs on EMB therapy or renal failure, shock or occurs on RMP therapy and vestibular dysfunction occurs on streptomycin therapy. With the exception of RMP (in case of shock or thrombocytopenia), EMB and streptomycin, other drugs can be reintroduced one by one when symptoms resolve, beginning with the drug that is least likely to cause the adverse effect. All drugs should be restarted at low dosages and dosages should be increased stepwise (Table 2). When no adverse effects occur after 3 days, additional drugs can be added. The drug that is most likely to be responsible for an adverse effect should be the last to be restarted if no alternative is available.

If toxic hepatitis occurs, all drugs should be stopped until the serum bilirubin and liver transaminases (aminotransferase) have normalized. In many cases, it is possible to reintroduce the causative drug (usually INH, RMP or PZA) with increasing dosage without further hepatic complications.

In all cases, when second-line drugs are used it is usually necessary to prolong the standard duration of treatment.

Table 2: Reintroduction of antituberculous drug following drug adverse event

Drug

Day 1

Day 2

Day 3

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