Hepatotoxic effects of tuberculosis therapy. A practical approach to a tricky management problem.
Side effects of the most commonly used first-line antituberculosis drugs range from minor gastrointestinal symptoms to severe hepatotoxicity. If unrecognized, they can lead to increased morbidity and mortality as well as to higher healthcare costs. Side effects are most evident in patients with underlying compromise in hepatic function. Erratic treatment protocols not only promote secondary drug resistance but also offset all gains in tuberculosis control. Recognition of this problem, mandatory directly observed therapy, judicious standardized follow-up planning, and implementation of modified treatment protocols when needed may play a dominant role in treating and controlling tuberculosis and may also prevent the morbidity and mortality sometimes associated with tuberculosis treatment. In view of the changing epidemiology of tuberculosis and its global impact, the American Thoracic Society and the Centers for Disease Control and Prevention may need to look closely into the issues outlined here to develop a consensus and establish more specific guidelines.
Ali
J
J
Department of Medicine, Louisiana State University Medical Center, New Orleans 70112-1393, USA. Jali@NOMVS.LSUMC.edu
D000904:Antibiotics, Antitubercular / Q000009:adverse effects / Q000493:pharmacokinetics; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D056486:Chemical and Drug Induced Liver Injury; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects / Q000493:pharmacokinetics; D008099:Liver / Q000187:drug effects*; D008107:Liver Diseases / Q000628:therapy; D011718:Pyrazinamide / Q000009:adverse effects / Q000493:pharmacokinetics; D012293:Rifampin / Q000009:adverse effects / Q000493:pharmacokinetics; D012307:Risk Factors; D014376:Tuberculosis / Q000188:drug therapy
D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D011718:Pyrazinamide; D007538:Isoniazid; D012293:Rifampin