Plethora of evidence revealed that the clinical profile of antituberculosis treatment (ATT)-induced hepatotoxicity varies, and the reintroduction of ATT in patients who have developed such injury is still debatable. The authors of the present study evaluated the clinical profile in patients with ATT-induced hepatotoxicity. In addition, they also assessed a predefined strategy of reintroduction of ATT. The trial included 72 consecutive patients with clinical evidence of ATT-induced hepatotoxicity. 

A total of 44 (61%) patients were presented with jaundice while prodromal symptoms were present in 28 (39%). Serious complications were reported in 12 (16.6%) patients; fulminant hepatic failure in seven, subacute hepatic failure in four, hepatic encephalopathy in one, whereas nine patients died from these complications. 

The outcome showed that the mean duration of treatment prior to the onset of hepatitis was remarkably longer in the group that died (53.22 ± 36.22 days) in comparison to remianing patients (31.07 ± 30.30 days). Finding of malnutrition was present in 37 among 72 patients. Reintroduction of isoniazid and rifampicin was done in 41 out of 44 patients, after the improvement of drug-induced hepatitis. 

Thus, it can be concluded that ATT-induced hepatitis could cause significant morbidity and mortality. In addition, malnutrition was found to be a common finding in patients with ATT-related hepatitis. Moreover, based on these findings, it is evident that potentially hepatotoxic antituberculosis drugs can be safely reintroduced after resolution of drug-induced hepatitis.

Source: Singh J, Garg PK, Tandon RK. Hepatotoxicity due to antituberculosis therapy. Clinical profile and reintroduction of therapy. J Clin Gastroenterol. 1996 Apr;22(3):211-4.