Management of hepatotoxicity to antituberculosis therapy (ATT) is a significant challenge, which often causes cessation of therapy. It is also associated with high risk of fulminant hepatic failure and mortality is high, once the development of icteric hepatitis occurs. However, there is no consensus on monitoring protocols and for the reintroduction of ATT.

The study included all patients with a diagnosis of tuberculosis, who were administered with ATT during the study period, for prospective periodic laboratory monitoring for the development of hepatotoxicity. These patients were categorized into Group A (n = 21) consisting of patients who developed hepatotoxicity, whereas those who did not develop hepatotoxicity constituted Group C (n = 179). All the patients who presented directly with ATT induced hepatotoxicity during the study period formed as Group B (n = 24) and were contrasted with Group A. Group A and B were further reviewed after regularization of liver functions for sequential reintroduction with therapeutic doses at a weekly interval.

The outcome showed that 66.6% (14 patients) of the patients were diagnosed in the asymptomatic period in Group A. However, seven patients had symptomatic hepatitis, but no patient reported had icteric illness. Group A showed no mortalities whereas all the patients in Group B had symptomatic hepatitis (75% icteric hepatitis). There was a mortality rate of 16.6%, and among 41 patients from Groups A and B who survived, reintroduction of ATT therapy was successful in 38/39 (97.4%). In the, Reintroduction was not tried in remaining two patients who were in Group B because of decompensated liver disease.

Therefore, it can be concluded that periodic laboratory monitoring is essential in diagnosing hepatotoxicity at an early stage, which in turn, can also prevent mortality. However, it was evident by the findings of the study that sequential reintroduction of ATT is often efficacious.

Source: Agal S, Baijal R, Pramanik S, Patel N, Gupte P, Kamani P, Amarapurkar D. Monitoring and management of antituberculosis drug induced hepatotoxicity. J Gastroenterol Hepatol. 2005 Nov;20(11):1745-52.