Tuberculosis (TB) is an airborne infectious disease caused by Mycobacterium tuberculosis, primarily affecting the lungs. The World Health Organization–recommended DOTS strategy employs first-line drugs—isoniazid, rifampicin, pyrazinamide, and ethambutol—to improve adherence and prevent resistance. However, prolonged multidrug therapy increases the risk of adverse drug reactions (ADRs) and drug–drug interactions (DDIs). This cross-sectional study, conducted over six months in a tertiary care hospital, included 250 TB patients receiving DOTS therapy. Data on demographics, treatment details, ADRs, and DDIs were systematically collected. A total of 230 patients (92%) experienced at least one ADR, with the highest incidence in the 50–59-year age group and a male predominance. Hepatotoxicity was the most common ADR. Most reactions were mild to moderate and assessed as probable. A significant number of DDIs were also observed, mainly due to polypharmacy. In conclusion, ADRs and DDIs are common during DOTS therapy. Although most are manageable, regular monitoring is essential to ensure patient safety and optimize treatment outcomes.
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