Management of antitubercular drugs-induced hepatotoxicity and therapy reintroduction strategy in a TB clinic of Nepal.

ABSTRACT

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. DESIGN: 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. CONCLUSION: 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.