Drug induced liver injury due to anti tuberculous chemotherapy in directly observed daily therapy in fifty patients : a retrospective study in Western India

摘要

Drug induced liver injury (DILI) is the most common adverse drug reaction leading to interruption of treatment in tuberculosis (TB). There are limited guidelines and treatment strategies on DILI due to anti TB drugs. (1) To study whether rapid reintroduction of drugs in DILI has any adverse outcome. (2) Rates of recurrent drug induced hepatitis. (3) Does DILI predispose a patient for drug resistant TB. Case record forms (CRFs) of 2113 patients were analyzed for the incidence of DILI. A total of 148 patients were diagnosed with hepatotoxicity and after careful exclusion 50 patients were diagnosed with DILI. All patients were reintroduced with all the drugs together once the hepatitis was resolved. A written informed consent was taken. Incidence of hepatotoxicity was 7%. Incidence of DILI was 2.4%. Female predominance was seen (68%). Majority of patients were suffering from pulmonary TB (72%). A mean of 14.2 days were lost before reintroduction. Recurrent DILI was seen in ten percent of patients (n=5). Six patients developed drug resistant tuberculosis due to interruption of treatment. (p value 0.031). Rapid reintroduction of drugs was well tolerated with recurrence rates of 10%. DILI predisposes a patient to develop MDR TB.