Management of Drug–Drug Interactions, Safety Outcomes, and Potential Pharmacist Involvement in the Treatment of Tuberculosis and Respiratory Viral Coinfections: A Systematic Review of Case Reports and Case Series

Background/Objectives: Coinfection with tuberculosis (TB) and respiratory viral infections (RVIs) complicates clinical management due to polypharmacy, potential drug–drug interactions (DDIs), and adverse drug reactions (ADRs). We aimed to evaluate patient-level treatment data, focusing on potential DDIs, reported or suspected ADRs, clinical outcomes, and opportunities for pharmacist involvement in the management of TB/RVI coinfection. Methods: This systematic review was registered in PROSPERO CRD420251125786 and conducted following PRISMA guidelines. We searched MEDLINE, PubMed, Embase, Web of Science, and Scopus for case reports and case series of TB/RVI coinfection. Study quality was assessed using the Joanna Briggs Institute (JBI) tools. Potential DDIs between TB medicines and concomitant medicines were assessed using three drug interaction checkers and synthesized descriptively. Results: A total of 186 patients described in 108 studies were included. The studies reported 79 single-patient and 29 two- or more patient-level data on treatment. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was the most frequently reported RVI (89.8%). An ADR was reported in 16 of 186 published cases (8.6%), mainly related to hepatotoxicity (11/21 ADR events; 52.4%), followed by anemia/cytopenia and gastrointestinal intolerance. Four contraindicated and 50 serious potential DDIs requiring close monitoring were identified, mostly involving rifampicin. Because the evidence consists of published case reports and case series, these proportions are descriptive rather than population risk estimates. Conclusions: TB/RVI coinfection is characterized by substantial polypharmacy, potential DDIs, and risk of ADRs. None of the included reports described pharmacist involvement. These findings suggest that pharmacist involvement in multidisciplinary TB services, together with co-treatment guidance, warrants evaluation to improve medication safety.