Association between ATT and Hepatotoxicity: Food for Thought
It is well known that anti tuberculosis therapy (ATT) is associated with the risk of hepatotoxicity in adults as well as children. This may range from mild asymptomatic elevations of liver enzymes to more serious hepatic injury including acute liver failure. In a series from Brazil, 10% of 81 liver transplants for acute liver failure (over a 10 y period) were related to ATT . Among the ATT agents, Isoniazid is the most frequent culprit, followed by Rifampicin and Pyrazinamide. In fact, a unique experiment wherein patients with drug sensitive TB received rifampicin for 2 wk in doses as high as 20, 25, 30, or 35 mg/kg, (in addition to standard doses of other drugs) showed similar frequency of adverse events compared to the standard 10 mg/kg and only one episode of hepatotoxicity . Investigations of alternate treatment regimens replacing isoniazid with moxifloxacin (in adults) showed higher incidence of hepatic injury, greater peak enzyme levels, and earlier onset of hepatotoxicity...
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