Prevalence and management out comes of anti TB drugs induced hepatotoxicity, St.Peter TB Specialized Hospital
AbstractBack Ground and Objectives: Tuberculosis is a major public health problem in the world, according to MOH in Ethiopia, in 1995 TB was the leading cause of out patient morbidity ranking 4th with 37%. WHO designed a strategy of treatment under direct observation (DOTS), but most of the anti TB drugs affect the liver and causes drug-induced hepatitis. This side effect was usually observed in St. Peter TB Specialized Hospital and there was a debate weather to discontinue all anti TB drugs so that drug resistance could be possibly avoided or partially so that patient could be protected from worsening of the underlined disease. Taking the above concept as a rationale a prospective study was conducted for one year with an over all objective to determine the prevalence of anti Tb drug induced hepatitis and to suggest the management out comes.
Patients and Methods: All TB patients admitted in the Hospital during the study period are the source of population, the study groups were been selected by detecting the possible confounding factors for jaundice. Base line LFT before anti TB initiation was determined before developed jaundice. Those patients, whom the jaundice is expected to be of anti TB drugs, were classified into two groups to be managed by 1) total and 2) partial discontinuation of the anti TB drugs.
Results: 516 (83.8%) of the admitted TB patients were qualified as a study group. The majority were in reproductive age group (15-49 years old.) (55.8%) were males. 332(64.3%) of this TB patients were new where as 110 (21.3%) patients were re treatment cases. The prevalence of jaundice supposed to be due to anti TB drugs induced hepatitis was 8.9% (46 patients); observed mostly with in 2 weeks of time, after anti TB initiation
25(54.3%). Among the jaundiced patients 41(89.1%) were newly treated and four (8.6%) retreated TB patients. Hence, there was statistically significant association between newly treated patients and risk of hepato toxicity (p<0.05). 14 male and 32 females were jaundiced revealing statistically significant association (p<0.0001). Further more, risk of jaundice is significantly associated with age (p<0.000001). As a management anti TB was discontinued totally in 33(71.7%) patients and partially in 13(28.3%) where only 14(30,4%) and 9(19.6) patients are cured respectively and there was no statistically significant association between the measures taken and the out comes observed (p>0.05) More over death after jaundice was significantly associated. (p<0.000001)
Conclusion: Most of the admitted TB patients were in the reproductive age group; this will have a negative feedback on the country's economy. Hence, prevention and early case detection needs strengthened. Some specific groups were prone to develop anti TB drug induced hepatitis. Hence, revision on dose administration needs to be proposed at least for these risk groups. There was similar effects observed on total and partial discontinuation of anti TB drugs after commencing jaundice, so one can substantiate either of the alternatives and here it is recommended that on going study is vital to conclude the impact of these managements in potentiating the development of drug resistance.
[J Ethiopia Med Pract. 2002;4(1): 32–38]