This should include AST (or ALT), platelet count and prothrombin

This should include AST (or ALT), platelet count and prothrombin time at least 2-weekly initially. Patients should be told to report symptoms such as anorexia, nausea, vomiting, abdominal pain or jaundice immediately [124,125]. Epigastric pain, nausea and vomiting are common especially in the first 2–3 weeks after starting anti-tuberculosis therapy. If the patient Dabrafenib supplier has no evidence of hepatic disease and is unresponsive to symptomatic treatment, for instance with anti-emetics,

then they can: take medications with meals (except with doses under 600 mg rifampicin daily); food delays or decreases the absorption of isoniazid and rifampicin but the effect is moderate and of little clinical significance; Patients should avoid dividing doses or changing to alternative drugs if at all possible, although dividing the dose, for instance of pyrazinamide, can improve tolerability. The NRTIs ddI and d4T cause peripheral neuropathy and there is an additive toxicity of isoniazid when used with d4T [118,126]. In individuals already taking these antiretrovirals, alternatives should be found if possible. Pyridoxine 10 mg daily should be used in all patients receiving isoniazid. If peripheral neuropathy occurs the dose of pyridoxine can be increased up to 50 mg three times a day. d4T should not be used as part of a HAART regimen if concomitant

isoniazid is being administered. In patients on HAART coming from resource-poor countries where d4T is used widely in initial for therapy, switching MK0683 to an alternate nucleoside should be performed. Rashes are often mild/moderate and usually occur in the first 2 months of treatment. They should be managed in a similar way to the management of nevirapine hypersensitivity rashes. Mild rashes without mucosal involvement can be treated symptomatically. More widespread worsening rashes or those with systemic symptoms require all drug cessation, and on recovery careful drug reintroduction as per protocol (see Table 8). One compounding issue is that patients may have also

recently started cotrimoxazole or antivirals and so the offending drug can be difficult to track down. In HIV infection, malabsorption has been reported with all first-line anti-tuberculosis drugs, as well as ethionamide and cycloserine. Absorption may be decreased in patients with a low CD4 cell count because of HIV enteropathy or other HIV-related gut disease. Subtherapeutic plasma drug concentrations may cause treatment failure and drug resistance [127,128]. Although some studies show lower peak concentrations of rifampicin and ethambutol as well as a lower AUC compared with controls [129–133], there are other data suggesting that rifampicin is well absorbed in HIV-infected patients, including those with AIDS or diarrhoea [134]. There are few data showing a correlation of treatment failure with poor absorption [106]. There are few data showing that TDM results in improved outcomes, and the use of TDM in TB has been reviewed [135].

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