The management of anti-tuberculosis drug-induced hepatotoxicity.
METHODS
A tuberculosis ward in a chest disease teaching hospital.


OBJECTIVE
To compare the efficacy of two different retreatment protocols on hepatotoxicity recurrence in tuberculosis treatment.


METHODS
In a prospective, randomised study, 45 patients with new tuberculosis developed hepatotoxicity after anti-tuberculosis treatment. Patients in Group I (n = 20) were retreated with a drug regimen consisting of isoniazid, rifampicin, ethambutol and streptomycin administered by gradually increasing the number and dosage of the drugs. Patients in Group II (n = 25) were retreated with the same regimen (isoniazid, rifampicin, pyrazinamide and ethambutol) in the same dosages throughout.


RESULTS
Hepatotoxicity recurred in respectively zero and six (24%) patients in Groups I and II (P = 0.021). Of the six patients with recurrence of hepatitis, one could not be followed up. The other five received the same retreatment protocol as Group I. By the end of retreatment, all patients were cured.


CONCLUSIONS
The recurrence rate of hepatotoxicity in the retreatment of tuberculosis is higher in the reintroduction of a full-dose regimen including pyrazinamide, which causes more hepatotoxicity than gradual reintroduction of a regimen without pyrazinamide.
Süreyyapaşa Center for Chest Disease and Thoracic Surgery, Istanbul, Turkey. kemaltaha@hotmail.com
K
K
Tahaoğlu
G
G
Ataç
T
T
Sevim
T
T
Tärün
O
O
Yazicioğlu
G
G
Horzum
I
I
Gemci
A
A
Ongel
N
N
Kapakli
E
E
Aksoy
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D014376:Tuberculosis / Q000188:drug therapy*
D000995:Antitubercular Agents