Monthly Medical Evaluation and the Diagnosis and Management of Paradoxical Reactions
A.II All patients should receive a monthly clinical evaluation (see Box 2(Table_B2)) to monitor their response to treatment, adherence to treatment, and medication side effects (Table 2A of Appendix). During the early days of therapy, the interval between these evaluations might be shorter (e.g., every 2 weeks).

A.II Patients suspected of having paradoxical reactions should be evaluated to rule out other causes for their clinical presentation (e.g., TB treatment failure) before attributing their signs and symptoms to a paradoxical reaction.

C.III Some experts recommend that to avoid paradoxical reactions, clinicians should delay the initiation of or changes in antiretroviral therapy until the signs and symptoms of TB are well controlled (possibly 4-8 weeks from the initiation of TB therapy).

No rating

For patients with a paradoxical reaction in whom the symptoms are not severe or life-threatening, the management of these reactions might consist of symptomatic therapy and no change in antituberculosis or antiretroviral therapy. For patients with a paradoxical reaction associated with severe or life-threatening clinical manifestations (e.g., uncontrollable fever, airway compromise from enlarging lymph nodes, enlarging serosal fluid collections pleuritis, pericarditis, peritonitis{}, sepsis-like syndrome), the management might include hospitalization and possibly a time-limited use of corticosteroids (e.g., prednisone started daily at a dose of 60-80 mg and reduced after 1 or 2 weeks, with the resolution of symptoms as a guide; in most cases, corticosteroid therapy should last no more than 4-6 weeks).

previous page | next page

return to table of contents