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Grades of Severity
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- Mild - Mild nausea & vomiting, Without any symptoms of dehydration
- Moderate - Slightly more nausea & vomiting, with symptoms of mild dehydration (increased thirst, dry tongue, mouth, etc.) and generalised weakness
- Severe - Excessive vomiting, Weakness and inability to stand, Sunken eyes with loss of skin elasticity and Electrolyte imbalance
- Potentially Life-Threatening - All symptoms of ‘severe category’, blood in vomit with a decrease in Urination, Altered level of consciousness
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Possible Offending Medications
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Isoniazid (H), Rifampicin (R), Pyrazinamide (Z) Ethionamide (Eto), Streptomycin (S), Prothionamide (Pto), P-aminosalicylic Acid (PAS), Clofazimine (Cfz), Bedaquline (Bdq)
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Level of Management
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Health Worker Level (Treatment supporter, ASHA, Community member)
- Counsel patients & reassure them that these symptoms resolve with time
- Remind patients -
- To do not take all the drugs together
- To take the drugs with little water
- To take the drugs embedded in banana or with milk or at bedtime
- To take a light meal (biscuits, bread, rice) before consuming the drugs
Sub Center Level (CHO, ANM & MPHW)
- Monitor and ensure hydration
- Give oral rehydration solution (ORS)
- Give domperidone/ omeprazole/ ranitidine metoclopramide 30 min before the patient consumes anti-TB drugs
Health Institutes Level (PHC, CHC, Hospitals)
- Give ondansetron* 30 min before the patient takes anti-tb drugs (Avoid ondansetron in patients who are on BDQ/DLM)
- Assess for danger signs (dehydration, electrolyte imbalance, hepatitis)
- Initiate rehydration therapy (intravenous) & replace electrolytes if required
- Divide/reduce the dose of offending/anti-tb drugs without compromising on the regimen
- If nausea & vomiting are anticipated, give a small dose of an anti-anxiety drug (5 mg diazepam) 30 min before drug intake
- Refer in case of Persists vomiting, blood in vomiting, Moderate to severe dehydration
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