eographically, the burden of TB is highest in Asia and Africa. India and China together account for almost 40% of the world's TB cases (WHO, 2012). TB is a highly infectious disease caused by Mycobacterium tuberculosis, which is the second leading cause of death d u e t o infection in the world. TB is a major public health problem in Bangladesh. The country ranks 6 th on the list of 22 highest burden TB countries in the world. Each hour eight persons die of the disease for which very effective treatment, free of cost, is available in Bangladesh. Before 1993 TB control was limited to TB clinics and TB hospitals. Field implementation of TB control integrated into the general health services, delivered by Upazila Health Complexes (UHC's), started back in 80s. However, National TB Control Programme (NTP) Bangladesh revised its strategies and adopted DOTS in 1993. NGO's have been involved since 1994 (NTP). detect 70% of new smear-positive pulmonary TB cases and cure at least 85 % of them by the year 2005 and be maintained thereafter to reach the Millennium Development Goal (MDG) by 2015 (NTP).

As the treatment of TB almost always involves combinations of drugs that are to be taken for a prolonged period of time, the occurrence of ADR is quite likely. Moreover, the adverse effect of one drug may be enhanced by the associated drug used which is one of the major reasons for the faulty patient treatment.

The common ADRs observed in DOTS involved mild gastritis, central nervous system, peripheral nervous system, psychiatric, Thus, a comprehensive understanding of the various ADRs along with their management is mandatory for the prevision, detection, and effectual TB management. It has become quite imperative to monitor the ADRs of patients on DOTS through the monitoring of ADRs and hence, the current study was undertaken.

Ten years ADR data (from 2002 to 2012) in the DOTS therapy caused by anti-TB drugs previously reported in various articles were searched from referred sources and observed carefully. The observed cases of different regions are listed in Table 1.

A total of 10219 patients were observed from previously studied articles. Among them 8047 (78.75%) patients showed at least one type of ADR. Dermatological ADRs were predominant (42.95%) which was followed by hepatotoxic reactions (15.99%). Different types of ADRs and there prevalence occuraence is depicted in Table 2 and Figure1 The overall goal of the NTP is to reduce morbidity, mortality and transmission of TB until the disease is no longer a public health problem. The objectives are to

The study says that, Isoniazid, rifampicin, and ethambutol are the drugs responsible for the skin reactions (F. Kurniawati et al., 2012). Arthralgia or gout which is prevalent in adults is mainly caused by isoniazid, ethambutol, and pyrazinamide that can be managed by Nonsteroidal Anti-inflammatory Drugs (NSAIDs). Children are less prone to hepatitis as compared to adults, mainly shown by pyrazinamide alone, isoniazid and rifampicin, isoniazid alone, and rifampicin alone. It can be reduced by starting therapy with ethambutol and pyrazinamide (F. Kurniawati et al., 2012).

The occurrence of ADRs among the female patients was marginally higher as compared to the male patients.This phenomenon is attributed to the alteration of drug responses mainly due to their lower body weight compared to the males. Different phases of life such as, pregnancy, menstruation cycles etc. also contribute to some extent in this regard (J J Furin et al., 2001; D.K. Tak et al., 2009).

ADR management should involve proper monitoring of the adverse reactions, postponing medication regimens, continuing the medication again without change and finally changing patient's treatment regimens. To reduce GI disorders antiemetic drugs and to alleviate dermatological antihistamines can be administered as add on therapies.

IV.

The occurrence of ADRs in the patients with DOTS is highly alarming; and immediate measures should be taken for the prevention of this phenomenon in order to minimize the potential serious health hazards including death. Pharmacists can play a significant role in the management of ADRs through patient counseling and improving their awareness.