TITLE:
The Role of Pyridoxine in the Prevention and Treatment of Neuropathy and Neurotoxicity Associated with Rifampicin-Resistant Tuberculosis Treatment Regimens: A Topic Review
AUTHORS:
Joseph G. Kariuki, Symon M. Kariuki, Phuti Angel
KEYWORDS:
Rifampicin-Resistant Tuberculosis, Pyridoxine, Vitamin B6, Neuropathy, Neurotoxicity, Multidrug-Resistant Tuberculosis, Extensively Drug-Resistant Tuberculosis
JOURNAL NAME:
Journal of Tuberculosis Research,
Vol.11 No.2,
May
11,
2023
ABSTRACT: Rifampicin-resistant tuberculosis (RR-TB) is a
global public health problem caused by mycobacterium tuberculosis resistant to
Rifampicin. Drug-induced peripheral neuropathy and neurotoxicity are well-known
adverse effects of treatment regimens that cause significant morbidity.
Pyridoxine is often added to treatment regimens for the prevention and/or
treatment of these side effects. The basis and effectiveness of this practice
are unclear. We conducted a systematic review to evaluate the effectiveness of
pyridoxine in preventing and/or treating neuropathy and neurotoxicity
associated with RR-TB treatment. We included studies with patients with RR-TB
who experienced neuropathy or neurotoxicity attributed to RR-TB regimens and
were given pyridoxine. Our findings showed contradicting evidence on the use of
pyridoxine for preventing or treating neurotoxicity due to cycloserine in the
treatment of RR-TB. Moreover, pyridoxine did not have a protective effect
against neuropathy and/or neurotoxicity caused by other RR-TB regimens that do
not contain isoniazid. In conclusion, we found that withdrawing or withholding
medications such as linezolid, cycloserine, thioamides, fluoroquinolones, and
ethambutol, implicated in causing neuropathy or neurotoxicity was more
effective than using pyridoxine to stop the progression of symptoms, and in
some instances, led to their reversal over time.