Hepatotoxicity to antituberculosis therapy (ATT)poses a key challenge and every so often results in inadequate therapy. Themenace of fulminant hepatic failure and impermanence is high, when icterichepatitis develops. There is no consent on monitoring procedures and for thereinstatement of ATT.

Patients, with a diagnosis of tuberculosis, whowere yet to obtain ATT during the study period, were involved in the presentstudy for prospective periodic laboratory monitoring for the development ofhepatotoxicity. Group A (n = 21), consists of hepatotoxicity patients, while patientswho did not develop hepatotoxicity were included in Group C (n = 179). All thepatients who presented directly with ATT induced hepatotoxicity in the studyperiod were categorized as Group B (n = 24). Group A and B were further examined,after normalization of liver functions for consecutive reintroduction withtherapeutic doses at a weekly interval.

In Group A, 14(66.6%) of the patients were detectedin the asymptomatic period. Seven patients had indicative hepatitis, but nonehad icteric illness. There were no mortalities in Group A. In contrast, all thepatients in Group B had symptomatic hepatitis (75% icteric hepatitis). Therewas a mortality rate of 16.6% (four patients) out of the 41 patients fromGroups A and B who lasted, reinstatement was successful in 38/39 (97.4%). Inthe left behind two patients of Group B, reintroduction was not tried becauseof decompensated liver disease.

Intermittent laboratory monitoring is imperative inspotting hepatotoxicity at an early stage, thus preventing mortality.Consecutive reintroduction is often successful.

Source: J Gastroenterol Hepatol, 2005Nov;20(11):1745-52.