Anti-Tuberculous Induced Hepatotoxicity


Background Anti-tuberculous drugs can induce liver injury. Although, it is usually mild and transient, but it can be presented in a form of markedly severe liver injury. Objective To assess the severity of hepatic injury that can be induced by the anti-tuberculous drugs and to evaluate the effect of different demographic features, duration of therapy and the presence of any other risk factors for liver injury on the frequency of anti-tuberculous drugs induced hepatotoxicity. Methods This cross sectional study had enrolled 30 patients who were on quadruple anti-tuberculous therapy regimen (Rifampicin and Isoniazid for 6 months and Pyrazinamide with streptomycin for the initial 2 months). They were randomly selected from those patients who had attend the outpatient clinic or admitted in the medical wards of Al-Yarmouk Teaching Hospital during the period between the 1st of Feb. 2006 to the 31st of January 2007. Results This study had enrolled 30 patients, 7 of them were female (23.3% of the sample), and 23 were male (76.7% of the sample). Male to female ratio was 3.28:1. This study revealed that 73.3% of those patients included in this study were older than 50 years old. 86.7% of the sample had less than 3 folds increase in their serum alanine aminotransferase (26 patients), only 4 patients (13.3% of the sample) had more than 3 fold increase in their serum alanine aminotransferase level more than the upper limit of normal range. 73.3% of the sample had increased serum bilirubin level by less than 3 times the upper limit of normal range. 46.7% of the sample (14 patients) were underweight. 70% of the sample (16 patients) had been included in this study within the first 2 months of anti-tuberculous therapy. 7 patients give history of regular alcohol intake (23.3% of the sample). While 4 patients had been discovered to be hepatitis B positive (13.3% of the sample). Jaundice was found in 9 patients (30% of the sample). Conclusion This study revealed that severe anti-tuberculous drugs induced liver injury is uncommon, increasing age is an important risk factor. It is unusual to find marked and very high level of alanine aminotransferase and bilirubin in patients using anti-tuberculous drugs. Being underweight can be regarded as a factor that may increase the risk of hepatotoxicity. Most of the cases of liver injury occur early from starting therapy. The presence of other risk factors that can induce liver injury can increase the risk of anti-tuberculous drug induced hepatotoxicity.