title: Elevated transaminases are common in children on prophylactic treatment for tuberculosis.
abstract: OBJECTIVE
  The aim of this study was to assess the prevalence of elevated transaminase levels in children undergoing prophylactic treatment for tuberculosis (TB) infection.
  
  
  METHODS
  All children living in a geographically defined area, who started TB prophylaxis during 2009-2011, were included. Data on background factors, treatment regimes and transaminase levels at baseline and follow-up were collected retrospectively.
  
  
  RESULTS
  Of the 277 children who were treated, 113 (41%) had elevated transaminase levels. Of these, 97 (35%) had levels that were less than three times the upper limit of the normal range and 16 (6%) had levels that were more than three times the normal range. Four patients had to discontinue isoniazid treatment and were successfully switched to rifampicin. In 17 patients, the highest transaminase peak did not occur until after 6 months of treatment. Elevated transaminases were significantly more common in patients below 9 years of age (62%) than in those aged 10-18 years (28%). Transaminases were elevated in 44% of all boys and 36% of all girls (p = 0.17).
  
  
  CONCLUSIONS
  Transaminase elevation was common in children receiving prophylactic treatment for TB and started at different points throughout the treatment period. Younger patients faced an increased risk. Regular blood tests are recommended throughout treatment.
authors.affiliation: Department of Pediatrics, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Leeb
authors.forename: Charlotte
authors.initials: C
authors.lastname: Buxbaum
authors.forename: Björn
authors.initials: B
authors.lastname: Fischler
mesh_terms: D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood*; D000995:Antitubercular Agents / Q000009:adverse effects*; D001219:Aspartate Aminotransferases / Q000097:blood*; D018890:Chemoprevention / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007538:Isoniazid / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D014376:Tuberculosis / Q000517:prevention & control*
chemical_list: D000995:Antitubercular Agents; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D007538:Isoniazid
keywords: Hepatotoxicity; Isoniazid; Prophylactic Treatment; Rifampicin; Tuberculosis