Anti-tuberclusis drugs induced hapatotoxicity

Abstract

The aim of this study is to investigate the Anti-tuberclusis drugs induced hapatotoxicity. Materials and Methods: This study was a cross sectional-inferential study and with complete enumirication method, all records of patients with tuberculosis treated with anti-tuberculosis treatment regimen (1598 cases) in the period between 2002 to 2018 in the East Azerbaijan Tuberculosis Center and Sina and Imam Reza hospitals in Tabriz, which according to the three definitions of hepatotoxicity, have suffered liver toxicity due to anti-tuberculosis drugs (64 cases). Demographic characteristics including age and sex and results such as clinical type of tuberculosis, treatment interval and incidence of treatment-induced hepatotoxicity, size of liver enzymes levels (AST and ALT), levels of total and direct serum bilirubin, type of treatment strategy, the time interval between discontinuation and normalization of liver enzymes and how to initiation of antituberculosis re-treatment were extracted from patients' files and entered into a project-specific questionnaire.

Results: In this study, 64 out of 1598 cases (0.4%) had hepatitis caused by anti-tuberculosis drugs. According to the three definitions of drug hepatotoxicity, 32 cases (0.50%), 27 cases (42.2%) and 37 cases (57.8%) were in the first to third definitions, respectively. The mean age of patients in this study was 56.1 (± 20.6) years and the majority of patients were women with 36 cases (56.3%). The most common type of tuberculosis was pulmonary tuberculosis with 44 cases (68.8%). The most common form of extrapulmonary tuberculosis was tuberculous adenitis with 11 cases (17.2%). The mean (SD) time interval between initiation of anti-TB treatment and incidence of hepatotoxicity and the time interval between discontinuation and normalization of liver enzymes in these patients were 18.7 (±13.1) and 13.8 (±7.1), respectively. The most common duration of treatment in patients was six-month treatment with 60 cases (93.8%). There was no significant relationship between the time interval between discontinuation and normalization of liver enzymes in pulmonary and extrapulmonary tuberculosis. The mean (SD) of liver enzymes (ALT and AST) of these patients were 269.1 (±181.1) and 219.1 (±140.2), respectively, while the total and direct serum bilirubin levels were 2.15 (±1.8) and 1.15 (±1.1), respectively.