| Substance | Common adverse effects | Management |
| Group I | ||
| Ethambutol | Optic neuropathy | Inform the patient to report decreased vision immediately. Discontinue and refer to an ophthalmologist if vision deteriorates. More likely to occur in patients with renal impairment. |
| Pyrazinamide | Hepatotoxicity, rash, gout | For hepatotoxicity, stop the drug; reintroduce in an escalating dose over several days. Discontinue drug if hepatotoxicity reoccurs. For rash, manage symptomatically; if extensive, stop drug and consider reintroduction. Discontinue if rash reoccurs. For gout, reduce dose initially and consider starting allopurinol when acute attack has settled. |
| Group II | ||
| Amikacin | Ototoxicity, nephrotoxicity | Monitor levels, hearing and renal function monthly. If problems occur, consider reducing dose frequency to three times a week. Discontinue if problems persist, but balance risk of cure versus deafness. |
| Capreomycin | Ototoxicity, nephrotoxicity | Monitor levels, hearing and renal function monthly. If problems occur, consider reducing dose frequency to three times a week. Discontinue if problems persist, but balance risk of cure versus deafness. |
| Kanamycin | Ototoxicity, nephrotoxicity | Monitor levels, hearing and renal function monthly. If problems occur, consider reducing dose frequency to three times a week. Discontinue if problems persist, but balance risk of cure versus deafness. |
| Group III | ||
| Levofloxacin | GI disturbances, tendinitis, insomnia | QT interval prolongation may be potentiated with other drugs |
| Moxifloxacin | GI disturbances, tendinitis, insomnia | QT interval prolongation may be potentiated with other drugs |
| Group IV | ||
| PAS | Nausea and vomiting, gastritis, hepatotoxicity, hypothyroidism | Rehydrate if necessary. Give antiemetics 30 min before the medication; several classes of antiemetic may need to be tried. Twice or three times a day divided dose may help. Gastritis can be helped by administering the drug with a small amount of food or giving an antacid or H2 blocker. For hypothyroidism, check TFT. |
| Prothionamide/ethionamide | GI disturbances, depression, hepatotoxicity, hypothyroidism | As above. Depression can be treated with an antidepressant if other causes excluded. |
| Terizidone/cycloserine | Neurotoxicity, peripheral neuropathy | Give high-dose pyridoxine, up to 50 mg for every 250 mg of drug. If neuropathy progresses, discontinue drug. Discontinue if psychosis develops. Seizures can be managed with anticonvulsants, but drug may need to be discontinued. |
| Group V | ||
| Amoxicillin/clavulanic acid | Hypersensitivity, GI disturbances | Not suitable for patients with penicillin allergy. |
| Clofazimine | Skin discolouration, GI disturbances | Inform the patient about discoloration of skin and body fluids |
| Imipenem | Hypersensitivity, neurotoxicity | Monitor blood count |
| Meropenem | Hypersensitivity, neurotoxicity | Monitor blood count |
| Linezolid | Neuropathy, anaemia | Monitor blood count; avoid prolonged use, when possible. Stop if peripheral neuropathy or haematological problems occur. Give with pyridoxine. |
| Isoniazid (high dose) | Peripheral neuropathy, hepatotoxicity | Give with pyridoxine |
PAS: p-aminosalicylic acid; GI: gastrointestinal; TFT: thyroid function test.