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Guideline for the Management of Anti-Tuberculosis (ATT) Induced Rash

Baljit Ahitan, Dr Heinke Kunst, Dr Martin Dedicoat
Respiratory Directorate
August 2011
October 2011
August 2013

Revision History
Version No.

Date of Issue

Author

August 11

Baljit Ahitan, Dr Heinke New Guideline

Kunst, Dr Martin
Dedicoat

Reason for Issue

1.

Overview/Introduction

This guideline has been developed to standardise the prescribing and monitoring of the
reintroduction of anti-tuberculosis medication in adult patients diagnosed with rash as an
adverse effect.

2.

Flow Chart

Refer to body of guideline.

3.

Objectives of the Guideline

1. To ensure safe and appropriate prescribing of ATT in patients diagnosed with rash as an
adverse effect.
2. To ensure all patients prescribed the re-introduction regimen are monitored appropriately.

4.

Body of Guideline

The flowchart below details the management of patients presenting with rash:

*When the above treatment has been discontinued in patients with severe TB, it may be
necessary to initiate three new drugs. Always seek specialist advice before prescribing.
Alternative treatment could include amikacin (or capreomycin or streptomycin), moxifloxacin
and prothionamide or cycloserine.

Medication Reintroduction Regimen

Day

Drug and dose

Isoniazid 50mg

Isoniazid 100mg

Isoniazid 300mg

Isoniazid 300mg + Rifampicin 150mg

Isoniazid 300mg + Rifampicin 300mg

Isoniazid 300mg + Rifampicin 450mg (Wt<50kg) or 600mg (Wt>50kg)

Isoniazid 300mg + Rifampicin 450mg or 600mg + Pyrazinamide 250mg

Isoniazid 300mg + Rifampicin 450mg or 600mg + Pyrazinamide 500mg

Isoniazid 300mg + Rifampicin 450mg or 600mg + Pyrazinamide 1.5g (Wt<50kg) or

2g (Wt>50kg)

10

Isoniazid 300mg + Rifampicin 450 or 600mg + Pyrazinamide 1.5g (Wt<50kg) or 2g

(Wt>50kg) + Ethambutol 100mg

11

Isoniazid 300mg + Rifampicin 450 or 600mg + Isoniazid 300mg + Pyrazinamide 1.5g

(Wt<50kg) or 2g (Wt>50kg) + Ethambutol 400mg

12

Isoniazid 300mg + Rifampicin 450 or 600mg + Isoniazid 300mg + Pyrazinamide 1.5g

(Wt<50kg) or 2g (Wt>50kg) + Ethambutol 15mg/kg

If patient has tolerated the individual components then consider prescribing combined
preparations.

5.

Reason for Development of the Guideline

The guideline assists all staff involved in the management of patients with tuberculosis (TB)
diagnosed with rash as an adverse effect. It also details the medication re-introduction
regimen for patients presenting with severe rash.

6.

Methodology

The draft guideline was written by the authors and further refined following consultation with
Christine Gunner (Medicines Information Manager), TB clinical nurse specialists, and Dr
Grace Smith (Consultant Microbiologist/Chair Birmingham TB Network).

7.

Implementation

This clinical guideline will be circulated to the appropriate clinical areas. An electronic
version will be available on the Trust internet site for access at all times.

8.

Monitoring

Adherence to the guideline will be monitored by respiratory/ID, pharmacy and nursing staff.

9.

Application of the Guideline

Clinicians, pharmacy and nursing staff will benefit from the guideline as it will provide clear
advice on the re-introduction and monitoring of ATT in TB patients diagnosed with rash as
an adverse effect within the trust.

10.

References
1) Treatment of Tuberculosis. American Thoracic Society, CDC, and Infectious
Diseases Society of America.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm
Accessed June 2010
2) Zaleskis, R. Postgraduate Course ERS Copenhagen 2005. The side-effects of TB
therapy. Breathe. September 2005 Vol 2 No 1