The clinical outline of antituberculosis treatment (ATT)-induced hepatotoxicity is inconstant, and the reinstatement of ATT in patients who have undergone such injury is debatable. In a prospective study to determine the clinical profile in patients with ATT-induced hepatotoxicity and to check a predefined policy of reintroduction of ATT, 72 successive patients with clinical evidence of ATT-induced hepatotoxicity were included. Jaundice was the giving symptom in 44 (61%) patients; prodromal symptoms were present in 28 (39%). Severe complications developed in 12 (16.6%) patients (7 with fulminant hepatic failure, 4 with subacute hepatic failure and one with hepatic encephalopathy. Nine patients (3 males, 6 females) died from these complications.

The mean interval of treatment before the onset of hepatitis was expressively longer in the group that died (53.22 ± 36.22 days) than in the rest of the patients (31.07 ± 30.30 days; p < 0.01). In 37 out of 72 patients malnutrition was present. After determination of drug-induced hepatitis, reintroduction of isoniazid and rifampicin was promising in 41 of 44 patients. Hence, the results showed that ATT-induced hepatitis carried significant morbidity and mortality, that malnutrition was communal in patients with ATT-related hepatitis, and that potentially hepatotoxic antituberculosis agents could be securely reintroduced after recovery from hepatitis.

Source: Journal of Clinical Gastroenterology:1996:22(3):211-214