Cutaneous adverse drug reactions to anti-tuberculosis drugs: state of the art and into the future

Expert Rev Anti Infect Ther. 2012 Apr;10(4):475-86. doi: 10.1586/eri.12.13.

Abstract

First- and second-line anti-tuberculosis drugs are associated with a diverse presentation of cutaneous adverse drug reactions (CADR), ranging from mild to life threatening. An individual drug can cause multiple types of CADR, and a specific type of CADR can be due to any anti-tuberculosis drug, which can make the management of tuberculosis (TB) following CADR challenging. The higher incidence of TB and CADR in HIV-infected persons makes TB-associated CADR a burgeoning problem for clinicians, particularly in high HIV-prevalence settings. This review discusses the pathogenesis, epidemiology, clinical presentation, diagnosis and management of TB-associated CADR. Clinical controversies including its impact on treatment outcomes, challenges in restarting optimal anti-tuberculosis therapy and the timing of highly active antiretroviral therapy initiation in those with HIV coinfection are also discussed. Finally, gaps in the current knowledge of TB-associated CADR have been identified and a research agenda has been proposed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • AIDS-Related Opportunistic Infections / microbiology
  • Anti-HIV Agents / therapeutic use
  • Antitubercular Agents / adverse effects*
  • Drug Eruptions / drug therapy
  • Drug Eruptions / epidemiology
  • Drug Eruptions / etiology*
  • Drug Eruptions / pathology
  • HIV Infections / complications
  • Humans
  • Tuberculosis / complications
  • Tuberculosis / drug therapy*

Substances

  • Anti-HIV Agents
  • Antitubercular Agents