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Tüberküloz tedavisinde hepatotoksisite risk faktörleri ve yönetimi

Management of and risk factors related to hepatotoxicity during tuberculosis treatment

Aylin BABALIK1, Hülya ARDA1, Nadi BAKIRCI2, Sinem AĞCA1, Korkmaz ORUÇ1, Şule KIZILTAŞ1,

1 Clinic of Chest Diseeases, Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital,

Istanbul, Turkey,

2 Department of Public Health, Faculty of Medicine, Acibadem University, Istanbul, Turkey.


Management of and risk factors related to hepatotoxicity during tuberculosis treatment

Introduction: Hepatotoxicity is one of the most frequent adverse events occurring during tuberculosis treatment that may negatively affect treatment compliance, clinical outcome. This study was designed to evaluate management, risk factors related to hepatotoxicity during tuberculosis treatment.

Patients and Methods: Hospitalized patients for tuberculosis treatment at Sureyyapasa Chest Diseases, and Chest Surgery Training and Research Hospital were included, between January 2004 and December 2007. Prevalence of hepatotoxicity, risk factors were evaluated among tuberculosis patients under anti-tuberculosis treatment according to World Health Organization (WHO) guideline. Hepatotoxicity was defined  any elevated liver function tests with accompanying symptoms. Age, gender, past history of anti-tuberculosis treatment, extensity of radiological findings, co-morbid disorders and drug resistance were the risk factors evaluated in terms of development and recurrence of hepatotoxicity.

Results: Of 1443 patients (38.37 ± 16.74 years; 64.5% were males), 106 (7.3%) was identified to develop hepatotoxicity on an average of 20 days after  beginning treatment and lasting an average of 14 days. Hepatotoxicity for once in 78.3% (n= 83) of patients  and more than once in 21.7% (n= 23) patients. All anti-tuberculosis drugs was continued at full dosage  after the normalization of liver enzyme  in 76.4% (n= 81). In recurrence  a step-by-step treatment was re-started by exclusion of responsible drug/s. Treatment was administered without modification of WHO regimes in 79.2%. Pyrazinamide was omitted in 15 cases while rifampicin only in one patient. Triple drug regimen with isoniazid, ethambutol and streptomycin was used in six cases. Quinolon was added to treatment only in one patient. Presence of a co-morbidity was determined to be significant predictor of hepatotoxicity development OR= 3.093 (CI= 1.95-4.89; p= 0.000) past history of anti-tuberculosis treatment was significantly associated with recurrence (p= 0.027). There was no hepatotoxicity dependent mortality.

Conclusion: Hepatotoxicity can be successfully management of hepatotoxicity without second line tuberculosis drugs in ongoing treatment regime.

Key Words: Hepatotoxicity, tuberculosis treatment, management, risk factors.

Received: 19/11/2011 - Accepted: 06/03/2012

Address for Correspondence:

Dr. Aylin BABALIK,

SB Süreyyapaşa Göğüs Hastalıkları ve

Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi,

Göğüs Hastalıkları Kliniği, İSTANBUL - TURKEY

e-mail: aylinbabalik@gmail.com

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