Management of DR-TB ADR: Giddiness

Adverse Drug Reaction (ADR), such as giddiness, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

Suspected agent(s) - Amikacin (Am), Ethionamide (Eto), Fluoroquinolone (FQ) and/or Pyrazinamide (Z)

Suggested Management Strategies

• Whenever a patient complains of giddiness, over-sleepiness or poor concentration, they should be provided counselling. 
• If severe, the offending drug should be identified by administering drugs individually and observing the response. 
• The dose of the offending drug identified may be adjusted or the offending drug terminated if required.
• Aminoglycosides, especially in the elderly age group must be kept in mind for giddiness as it may be an early sign of 8th nerve toxicity.

Point to Note: In cases of severe giddiness, the patient may be referred to the neurologist for further management as per the standard protocols.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• Ready Reckoner for Medical Officer- Adverse Drug Reactions Associated with Anti-TB Drugs Identification and Management, 2019.
• Technical and Operational Guidelines for TB in India, 2016.