Management of antitubercular drugs-induced hepatotoxicity and therapy reintroduction strategy in a TB clinic of Nepal.
BACKGROUND
PZA, INH and R have potential for hepatotoxic side effects. Although anti-tuberculosis drug-induced hepatotoxicity is well known, there is no agreement on the clinical approach for cases in whom hepatotoxicity has developed.


OBJECTIVE
To study the management of anti-TB drugs induced hepatotoxicity and the standard anti-TB drugs therapy reintroduction procedure.


METHODS
In prospective cohort analysis, 4 patients with active TB infection had developed anti-TB drugs induced hepatotoxicity. Retreatment of therapy was done on the basis of severity of hepatitis. If damage is mild, all the drugs were reintroduced at once in a tapering dose and if patient's condition is worse, INH and E is introduced in lower dose, later increasing the dose and the number of drugs.


RESULTS
All the patients tolerated anti-TB drugs well after reintroduction. There was no incidence of recurrence. All the patients completed their 8 months treatment regimen and all are cured.


CONCLUSIONS
Timely detection and temporary withdrawal of the offending agent can completely cure anti-TB drugs induced hepatotoxicity. The recurrence of hepatotoxicity is rare if reintroduction in done in a well planned manner.
Shakya
R
R
Department of Pharmacy, Kathmandu University. rajani@ku.edu.np
Rao
B S
BS
Shrestha
B
B
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal; D011446:Prospective Studies; D014376:Tuberculosis / Q000188:drug therapy*
D000995:Antitubercular Agents