Anti-tuberculosis drug inducd hepatitis - a Sri Lankan experience.

OBJECTIVE: To assess the incidence of anti-tuberculosis (TB) drug induced hepatitis (AIH) in Sri Lankan patients, determine risk factors of AIH, and to address management options in AIH. DESIGN: A prospective study. SETTING: Chest Hospital, Welisara, Sri Lanka, from April 2001 to April 2002. PATIENTS: Seven hundred and eighty three patients with a confirmed diagnosis of TB and resident in the Colombo and Gampaha districts who presented to Chest Hospital, Welisara, Sri Lanka. METHODS: WHO recommended treatment was commenced in all cases. AIH was diagnosed when patients complained of decreased appetite with nausea or vomiting and elevated serum bilirubin (SB; >1.1 mg/dL) or elevated serum alanine transferase (ALT; > 3 times upper limit of normal). RESULTS: Of 783 enrolled patients, 74 (9.5%) developed AIH, the majority (58%) developing AIH within the first 2 weeks of the intensive phase of treatment. AIH was more common among patients over 60 years (p = 0.018), who developed pulmonary TB (p = 0.028), and in patients weighing 33-55 kg (p = 0.004). Age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60, treatment modified in six, two defaulted and six died. CONCLUSIONS: The incidence of AIH in Sri Lanka is 9.5% in treated patients. AIH was associated with age, low body weight and rifampicin overdosage.

Outcome of treatment of multidrug resistant tuberculosis.

Multidrug resistant tuberculosis (MDRTB) is a growing problem worldwide. It is an emerging problem in Sri Lanka too although the exact data are not known. This report describes treatment and outcome of 14 MDRTB patients. All have had previous anti-tuberculosis treatment. Out of 32 previous treatment episodes, treatment has been either irregular or defaulted in 26(81%), which has largely contributed to the emergence of drug resistance. Treatment commenced with a combination of second line anti-tuberculosis drugs, namely, amikacin, ciprofloxacin, ethionamide, clofazimine and pyrazinamide. Four patients were considered cured, another four failed treatment, five defaulted treatment and one died. Previous sensitivity to second line drugs and proper isolation facilities were not available. Preparedness to face the threat of MDRTB is essential. Measures should be taken to reduce the rate of defaulters of anti-tuberculosis treatment, and facilities to treat MDRTB should be expanded.