Comparison the safety between two different reintroduction regimens after development of anti-tuberculosis druginduced hepatotoxicity

Abstract

Objective To compare the efficacy of two different dosage regimens on hepatotoxicity recurrence in tuberculosis treatment.Methods Eighty-eight cases with antituberculosis drug-induced liver injury in according with diagnosis standard were divided into 2 groups (group A and group B).Patients in group A (n =44) were retreated with the same regimen (isoniazid,rifampicin,pyrazinamide and ethambutol) in the same dosages throughout.Patients in group B (n =44) were given isoniazid and rifampicin by gradually increasing the type and dosage of the drugs on the basis of ethambutol,levofloxacin and streptomycin.In group B,streptomycin was stopped when isoniazid and rifampicin were tolerated.The hepatotoxicity recurrence rates in different dosage regimens were observed.Results Hepatotoxicity recurred in 10(22.7％)and 3 (6.8％) patients in groups A and B (x2=4.42,P ＜ 0.05),respectively.Two patients in group A quit the treatment,because of the serious hepatotoxicity,the other 8 patients with recurrence of hepatitis received the same retreatment protocol as group B.By the end of retreatment,all patients were cured without hepatotoxicity again.Conclusions The recurrence rate of hepatotoxicity is higher in the full-dose regimen including pyrazinamide,which causes more hepatotoxicity than gradual reintroduction of a regimen without pyrazinamide. Key words: Tuberculosis; Hepatotoxicity; Reintroduction regimens