Study of anti-tuberculosis drug induced hepatotoxicity in tubercular patient under treatment

Abstract

Aims: To find out the frequency of hepatotoxicity in recipients of the anti-tubercular drugs, predictive and risk factors and Methods to continue anti tubercular therapy in patients who are developing features of hepatotoxicity.
Materials and methods: It is a prospective study included a total of 120 patients suffering from pulmonary and extra pulmonary tuberculosis. 100 patients (68 male and 32 female) completed the study (January 2014 to September 2015). 15 patients were lost to follow up and 5 patients died (1 due to fulminant hepatic failure and other 4 due to non-hepatological causes). Results: The prevalence of hepatotoxicity in our study was 3% (3/100).The maximum prevalence of toxicity (3.77%) was found in 20 -39 years age group. The prevalence of hepatotoxicity was found more in females than in males (3.12% vs 2.94% respectively). All the ATD hepatotoxicity occurred in patients having BMI <17.9 (5.66%). These 3 patients also had low serum albumin level. So, it appears that low BMI and low serum albumin level which are pointers of under nutrition and poor socioeconomic status are risk factors for development of hepatotoxicity.Clinical parameters like nausea, vomiting, jaundice, ascites, edema, encephalopathy and coagulopathy are the main presenting features of drug induced liver disease. All the three patients having ATD hepatotoxicity had pulmonary tuberculosis and received CAT I DOTS under RNTCP. But in our study there was a short number of cases of extra pulmonary tuberculosis (2/100) and only 27% CAT II.Conclusion:Considering the low prevalence of hepatotoxicity in our study; DOTS under RNTCP may be implemented successfully without much fear for hepatotoxicity.