Determination of safe anti-tubercular therapy regimen following anti-tubercular drug induced hepatitis in patients with active tuberculosis
Journal Title: Journal of the Indian Medical Association - Year 2019, Vol 117, Issue 5
Abstract
To determine the safety of restarting isoniazid and rifampicin and etambutol or isoniazid pyrazinamid and ethambutol in patients who develop antitubercular drug induced hepatitis. In 22 tuberculosis patients, who developed antitubercular drug induced hepatitis were analysed, for reintroduction of antitubercular drugs, isoniazid, rifampicin and ethambutol in 11 patients (Group A) and isoniazid, pyrazinamide and ethambutol in another 11 patients (Group B), following clinical and biochemical (liver function test) normalization. During antitubercular drug induced period, hepatotoxic antitubercular drugs were withdrawn till clinical and biochemical normalization and non-hepatotoxic antitubercular drugs like streptomycin, ethambutol were given. Jaundice appeared at variable interval of 2-13 weeks after starting the antitubercular treatment and before enrolling into the study. All 22 patients with abnormal liver function on close followup, came back to normal within 2 weeks of stoppage of antitubercular drug. On rechallange, 4 out of 11 patients receiving isoniazid and rifampicin developed hepatitis within 2-4 weeks of restart of therapy and 1 out of 11 developed (receiving isoniazid and pyrazinamide) in 4th week. Though the study sample size was small, the combination of isoniazid and pyrazinamide was apparently safer compared to isoniazid and rifampicin combination though it was statistically insignificant (p<0.155).
Authors and Affiliations
Atanu Ghosh
Keywords
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