Side Effects of First-Line Anti-tubercular Therapy (ATT): Does an Alternative Regimen Exist?

Area of Science:

• Tuberculosis Treatment
• Pharmacology
• Clinical Medicine

Background:

• Standard anti-tubercular therapy (ATT) involves a 2HRZE/4HRE regimen.
• Adverse effects and comorbidities frequently require non-standardized treatment plans.

Purpose of the Study:

• To evaluate the use, rationale, and outcomes of non-standard ATT regimens.
• To assess the effectiveness of modified ATT in drug-sensitive tuberculosis patients.

Main Methods:

• A prospective observational study of 148 patients at a tertiary care hospital.
• Patients received non-standard ATT due to adverse effects or comorbidities.
• Follow-up focused on the intensive phase of treatment.

Main Results:

• Drug-induced liver injury (53.4%) and GI intolerance (21.6%) were primary reasons for non-standard ATT.
• HRE was the most common alternative regimen (35.1%).
• 76% showed clinical improvement and 60.1% radiological resolution by the intensive phase end; no adverse effects noted with modified regimens.

Conclusions:

• Non-standard ATT is often necessary due to adverse drug reactions, especially hepatotoxicity.
• Modified regimens led to significant symptomatic and radiological improvement in most patients.