Administration Order for Esomeprazole and Anti-TB Medications

Rationale for Administration Order

The American Thoracic Society recommends that first-line antituberculosis medications should be administered together; split dosing should be avoided to maintain therapeutic efficacy 1
Although ingestion with food delays or moderately decreases the absorption of antituberculosis drugs, the effects of food are of little clinical significance 2
If patients experience gastrointestinal distress with first-line TB drugs, dosing with meals or changing the hour of dosing is recommended rather than splitting doses or changing to second-line drugs 3

Gastrointestinal upset is common in the first few weeks of antituberculosis therapy, but first-line drugs (particularly rifampin) must not be discontinued because of minor side effects 2
For patients experiencing epigastric distress or nausea, the American Thoracic Society suggests administering TB medications with food rather than splitting doses 3
Consider using fixed-dose combination preparations which may be administered more easily than single drug tablets 1

Assess for hepatotoxicity, which is the most serious common adverse effect of TB medications 3
Monitor liver function tests at baseline and periodically during treatment, especially in patients with known chronic liver disease 4
If drug-induced hepatitis occurs, stop hepatotoxic TB drugs immediately 3