Adverse effects — MSF Tuberculosis — Médecins Sans Frontières 2026

MSFClinical guideline (chapter)Current edition

From Tuberculosis › Chapter 10: Treatment of multidrug-resistant and rifampicin-resistant tuberculosis · Médecins Sans Frontières, Current online edition, 2026

Management principles for adverse effects during multidrug-resistant and rifampicin-resistant tuberculosis treatment.

In one sentenceRapidly treat adverse effects during MDR/RR-TB treatment; prevent peripheral neuropathy routinely, manage symptomatic effects, and have only the managing clinician modify or stop treatment when serious effects occur.

Issuer: Médecins Sans Frontières
Edition: Current online edition, 2026
Audience: Clinicians managing MDR/RR-TB, nurses, treatment supporters
Evidence: Expert consensus
Reviewed: 23 Oct 2026 · GMJ

Read the original on MSF Whole guideline (PDF)

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 23 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This section of the MSF tuberculosis guideline addresses the management of adverse effects arising during treatment of multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB). It emphasises that rapid and aggressive treatment of adverse effects is essential to improve tolerance and treatment outcomes.

The guidance categorises adverse effects into those that should be routinely prevented (such as peripheral neuropathy), those that can be managed symptomatically (such as arthralgia due to pyrazinamide), those that are not serious but require patient reassurance (such as skin discolouration due to clofazimine), and those that are serious and may require dose reduction or drug interruption (such as optic neuritis due to linezolid). Patients should be informed that adverse effects are likely and should report them immediately to health staff, with only the managing clinician authorised to modify or stop TB treatment.

Key points

For clinicians — doses and thresholds as stated in the guideline

Rapid and aggressive treatment of adverse effects is essential to improve tolerance and treatment outcomes
Some adverse effects should be routinely prevented, specifically peripheral neuropathy
Arthralgia due to pyrazinamide can be managed with symptomatic treatment
Skin discolouration due to clofazimine is not serious but requires patient reassurance until it subsides spontaneously
Optic neuritis due to linezolid is a serious adverse effect that may require dose reduction or temporary or permanent drug interruption
Only the managing clinician can modify or stop TB treatment; treatment supporters and nurses must rapidly report adverse effects to the clinician
Adverse effects can appear at any time during treatment and patients should report them immediately

From the guideline

Verbatim

“Rapid and aggressive treatment of adverse effects is essential to improve tolerance and treatment outcomes.”

— Médecins Sans Frontières, Adverse effects — MSF Tuberculosis, Section 10.7 (2026)

Editor’s perspective

Why this matters for Georgia and the region

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration

As Georgia continues to address its multidrug-resistant tuberculosis burden, this MSF guidance on adverse effect management provides essential practical direction for our national TB programme. I would stress to Georgian clinicians the principle that only the managing clinician—not nurses or treatment supporters—can modify or stop TB treatment, even when serious adverse effects occur; this requires strengthening clinical decision-making capacity at the facility level. The challenge for implementation in our context will be ensuring reliable access to medications for both prevention (such as pyridoxine for peripheral neuropathy prophylaxis) and symptomatic management across all TB treatment sites, particularly in rural areas where supply chains may be less robust.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 23 Oct 2026

Applicability

Georgia and the South Caucasus

For Georgia and the South Caucasus region, where multidrug-resistant tuberculosis rates remain significant, this guidance on adverse effect management is highly relevant to national TB programmes. Georgian clinicians managing MDR/RR-TB will need to ensure systems are in place for patients to report adverse effects immediately, that treatment supporters and nurses are trained to recognise and rapidly escalate adverse effects, and that clear protocols exist specifying that only the managing clinician can modify treatment. National programmes should ensure access to the referenced Appendix 17 for detailed adverse effect management protocols and should stock medications for both prevention (for peripheral neuropathy) and symptomatic management of common adverse effects.

Questions this guideline answers

Quick answers

Which adverse effects should be routinely prevented during MDR/RR-TB treatment?

Peripheral neuropathy should be routinely prevented. The document notes that some adverse effects should be routinely prevented but only specifies peripheral neuropathy as an example.

Can a nurse or treatment supporter stop a TB drug if a patient reports serious adverse effects?

No. Only the managing clinician can modify or stop TB treatment. Treatment supporters and nurses should rapidly report adverse effects to the clinician, but cannot make treatment decisions themselves.

How can we identify which drug is responsible for an adverse effect?

Ascertaining the responsible drug can be challenging. Temporarily stopping a drug or reducing the dose can help identify which drug is causing the adverse effect.

What should patients be told about adverse effects before starting MDR/RR-TB treatment?

Patients should be informed that they are likely to experience adverse effects and should report them immediately to health staff. Adverse effects can appear at any time during treatment.

Related on GMJ

Interconnected resources

Dictionary of Public Health

Optic neuritis

Drugs A–Z

Linezolid

GMJ News coverage

Quality & accreditation

Same guideline

Patient Monitoring — Multidrug-Resistant and Rifampicin-Resistant Tuberculosis — MSF TuberculosisChapter 10: Treatment of multidrug-resistant and rifampicin-resistant tuberculosis
Special situations in multidrug-resistant and rifampicin-resistant tuberculosis treatment — MSF TuberculosisChapter 10: Treatment of multidrug-resistant and rifampicin-resistant tuberculosis
Treatment regimens in operational research conditions — MSF TuberculosisChapter 10: Treatment of multidrug-resistant and rifampicin-resistant tuberculosis
Treatment Regimens in Programmatic Conditions for Multidrug-Resistant and Rifampicin-Resistant Tuberculosis — MSF TuberculosisChapter 10: Treatment of multidrug-resistant and rifampicin-resistant tuberculosis
Treatment of Multidrug-Resistant and Rifampicin-Resistant Tuberculosis: Introduction — MSF TuberculosisChapter 10: Treatment of multidrug-resistant and rifampicin-resistant tuberculosis
Patient monitoring — MSF TuberculosisChapter 9: Treatment of drug-susceptible tuberculosis

Adverse effects — MSF Tuberculosis

What this guideline says

Key points

From the guideline