The Efficacy of Pyridoxine for Treatment of Neuropathy and Neurotoxic Side Effects in Rifampicin-Resistant Tuberculosis

This chapter assess the effectiveness of integrating Pyridoxine (Vitamin B6) in treatment regimens for preventing and treating peripheral neuropathy and neurotoxic adverse events associated with Rifampicin-resistant tuberculosis (RR-TB) medications. A systematic review was conducted to evaluate the practice of administering pyridoxine in the prevention and/or treatment of neuropathy and neurotoxicity related to RR-TB treatment. The study population consisted of patients with RR-TB who experienced neuropathy and/or neurotoxicity due to RR-TB regimens and received pyridoxine.

Contradictory evidence was found regarding the use of pyridoxine in preventing or treating neurotoxicity caused by cycloserine in RR-TB treatment. Additionally, pyridoxine did not demonstrate a protective effect against neuropathy and/or neurotoxicity associated with other RR-TB regimens lacking isoniazid. Our review indicated that discontinuing or withholding medications such as linezolid, cycloserine, thioamides, fluoroquinolones, and ethambutol, known to contribute to neuropathy or neurotoxicity, was more effective than using pyridoxine in halting the progression of symptoms, and in certain cases, even resulted in symptom reversal over time. Furthermore, comorbidities that predispose them to developing these adverse events should be routinely assessed and, when elicited, adequately managed.