ReviewInfection and drug resistance2026
Common Adverse Reactions and Management Strategies of First-Line Anti-Tuberculosis Drugs.
Review in Infection and drug resistance, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Comparison of a pharmacovigilance screening heuristic with expert clinical consensus for adverse drug reaction signal classification at a Pakistani tertiary care hospital.Pakistan journal of medical sciences · 2026Article
- Global Burden of Tuberculosis and Drug-Resistant Subtypes Among Women of Childbearing Age from 1990 to 2021, with Projections to 2030.International journal of women's health · 2026Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This review synthesizes evidence from recent clinical and mechanistic studies published between 2015 and 2024 to provide updated insights into the prevention and management of adverse drug reactions (ADRs) associated with first-line anti-tuberculosis drugs (ATDs)-namely isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA), and ethambutol (EMB)-which are essential for tuberculosis (TB) treatment but frequently cause significant ADRs that threaten therapeutic success. We examine four major toxicities: hepatotoxicity (primarily from INH and RIF, mediated by oxidative stress, mitochondrial dysfunction, and cytochrome P450 induction); peripheral neuropathy (driven by INH-induced pyridoxine depletion and EMB-related copper chelation leading to optic and axonal damage); central nervous system (CNS) toxicity (notably INH-induced seizures due to GABAergic disruption); and myelosuppression (mainly RIF- or PZA-related, involving oxidative injury to hematopoietic stem cells and impaired DNA synthesis). Key risk factors include advanced age, malnutrition, pre-existing organ dysfunction, and pharmacogenetic variations (eg, NAT2 acetylator status). Management strategies emphasize protocol-driven monitoring-including baseline and serial liver function tests (LFTs), complete blood counts (CBC), neurologic exams, and monthly visual assessments for EMB-and graded interventions based on severity thresholds (eg, temporary discontinuation if ALT >3× upper limit of normal (ULN) with symptoms or >5× ULN asymptomatic), alongside targeted therapies such as pyridoxine for neuropathy and N-acetylcysteine for hepatotoxicity. Proactive measures, including pretreatment risk stratification, patient education, and multidisciplinary coordination, are critical to optimizing adherence and outcomes. Effective management of first-line anti-TB drug toxicity requires mechanism-informed monitoring, individualized interventions, and proactive patient education to maintain treatment adherence and improve global TB outcomes.
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Registered trials
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