Document Detail

Monitoring and management of antituberculosis drug induced hepatotoxicity.
MedLine Citation:
PMID:  16246196     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Hepatotoxicity to antituberculosis therapy (ATT) poses a major challenge. This often results in inadequate therapy. The risk of fulminant hepatic failure and mortality is high once icteric hepatitis develops. There is no consensus on monitoring protocols and for the reintroduction of ATT. METHODS: All patients (from the Department of Internal Medicine and Gastroenterology, Jagjivanram Hospital and the Department of Gastroenterology, Bombay Hospital, Mumbai, India) with a diagnosis of tuberculosis, who were to receive ATT during the study period, were included in the present study for prospective periodic laboratory monitoring for the development of hepatotoxicity. Those patients who developed hepatotoxicity formed Group A (n = 21), whereas those who did not develop hepatotoxicity were included in Group C (n = 179). For the purpose of comparison with Group A, all the patients who presented directly with ATT induced hepatotoxicity during the study period were categorized as Group B (n = 24). Group A and B were further studied after normalization of liver functions for sequential reintroduction with therapeutic doses at a weekly interval. RESULTS: In Group A, 66.6% (14 patients) of the patients were diagnosed in the asymptomatic period. Seven patients had symptomatic hepatitis, but none had icteric illness. There were no mortalities in Group A. In contrast, all the patients in Group B had symptomatic hepatitis (75% icteric hepatitis). There was a mortality rate of 16.6% (four patients). Of the 41 patients from Groups A and B who survived, reintroduction was successful in 38/39 (97.4%). In the remaining two patients who were in Group B, reintroduction was not attempted because of decompensated liver disease. CONCLUSIONS: Periodic laboratory monitoring is important in detecting hepatotoxicity at an early stage, thereby preventing mortality. Sequential reintroduction is often successful.
Subhash Agal; Rajiv Baijal; Snehanshu Pramanik; Nikhil Patel; Parijat Gupte; Praful Kamani; Deepak Amarapurkar
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  20     ISSN:  0815-9319     ISO Abbreviation:  J. Gastroenterol. Hepatol.     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-10-25     Completed Date:  2006-01-23     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  1745-52     Citation Subset:  IM    
Department of Gastroenterology, Jagjivanram Hospital, Mumbai, India.
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MeSH Terms
Antitubercular Agents / adverse effects*,  therapeutic use
Drug Monitoring*
Drug-Induced Liver Injury / diagnosis*,  epidemiology,  mortality,  therapy*
Liver Function Tests
Middle Aged
Prospective Studies
Treatment Outcome
Tuberculosis / drug therapy*
Reg. No./Substance:
0/Antitubercular Agents

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