Isoniazid Hepatotoxicity Associated With Treatment of Latent Tuberculosis Infection

Fountain, Francis F.; Tolley, Elizabeth A.; Chrisman, Cary R.; Self, Timothy H.

doi:10.1378/chest.128.1.116

Cited by 231 publications

(141 citation statements)

References 16 publications

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“…(68) In children who have been in contact with a case of pulmonary TB, have no symptoms, and present normal X-ray findings, the TST is considered positive if the induration is ≥ 5 mm (children not vaccinated with BCG or vaccinated more than 2 years prior) or ≥ 10 mm (children vaccinated with BCG 2 or less than 2 years prior). In immunocompromised patients, the TST is considered positive when the induration is ≥ 5 mm, regardless of age or BCG vaccination status.…”

Section: Ltbmentioning

confidence: 99%

III Diretrizes para Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia

Conde¹,

Melo²,

Marques³

et al. 2009

J. bras. pneumol.

179

161

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New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations on TB have been evaluated, discussed by all of the members of the BTA Committee on TB and of the TB Work Group, and highlighted. The first version of the present Guidelines was posted on the BTA website and was available for public consultation for three weeks. Comments and critiques were evaluated. The level of scientific evidence of each reference was evaluated before its acceptance for use in the final text.Keywords: Tuberculosis; Mycobacterium infections; Diagnosis; Tuberculosis, multidrug-resistant. ResumoDiariamente novos artigos científicos sobre tuberculose (TB) são publicados em todo mundo. No entanto, é difícil para o profissional sobrecarregado na rotina de trabalho acompanhar a literatura e discernir o que pode e deve ser aplicado na prática diária juntos aos pacientes com TB. A proposta das "III Diretrizes para TB da Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)" é revisar de forma crítica o que existe de mais recente na literatura científica nacional e internacional sobre TB e apresentar aos profissionais da área de saúde as ferramentas mais atuais e úteis para o enfrentamento da TB no nosso país. As atuais "III Diretrizes para TB da SBPT" foram desenvolvidas pela Comissão de TB da SBPT e pelo Grupo de Trabalho para TB a partir do texto das "II Diretrizes para TB da SBPT" (2004). As bases de dados consultadas foram LILACS (SciELO) e PubMed (Medline). Os artigos citados foram avaliados para determinação do nível de evidência científica, e 24 recomendações sobre TB foram avaliadas, discutidas por todo grupo e colocadas em destaque. A primeira versão das "III Diretrizes para TB da SBPT" foi colocada no website da SBPT para consulta pública durante três semanas, e as sugestões, críticas e o nível de evidência da referência científica que as embasavam foram avaliados e discutidos antes de serem incorporadas ou não ao texto final.Descritores: Tuberculose; Infecções por Mycobacterium; Diagnóstico; Tuberculose resistente a múltiplos medicamentos.

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Section: Ltbmentioning

confidence: 99%

III Diretrizes para Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia

Conde¹,

Melo²,

Marques³

et al. 2009

J. bras. pneumol.

179

161

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“…27 Approximately 0.5% of all patients treated with INH monotherapy develop clinically important increases in aminotransferase levels. 28 In patients who are receiving combination therapies that include INH but not RIF, the incidence of hepatotoxic effects is around 1.6%; the corresponding value for regimens containing both INH and RIF is 2.5%. 29 INH itself is not hepatotoxic; toxicity is mediated through its metabolite, hydrazine.…”

Section: First-line Drugs Isoniazidmentioning

confidence: 99%

A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

Dhiman

Saraswat

Rajekar

et al. 2012

Journal of Clinical and Experimental Hepatology

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Tuberculosis remains one of the 'Captains of the Men of Death' even today, particularly in the developing world. Its frequency is increased 14-fold in patients with chronic liver diseases (CLD) and liver cirrhosis, more so in those with decompensated disease, probably due to the cirrhosis-associated immune dysfunction syndrome, and case-fatality rates are high. The diagnosis of tuberculosis, particularly the interpretation of the Mantoux test, is also fraught with difficulties in CLD, especially after previous BCG vaccination. However, the greatest challenge in the patient with CLD or liver cirrhosis and tuberculosis is managing their therapy since the best first-line anti-tuberculosis drugs are hepatotoxic and baseline liver function is often deranged. Frequency of hepatotoxicity is increased in those with liver cirrhosis, chronic hepatitis B and chronic hepatitis C, possibly related to increased viral loads and may be decreased following antiviral therapy. If hepatotoxicity develops in those with liver cirrhosis, particularly decompensated cirrhosis, the risk of severe liver failure is markedly increased. Currently, there are no established guidelines for anti-tuberculosis therapy (ATT) in CLD and liver cirrhosis although the need for such guidelines is self-evident. It is proposed that ATT should include no more than 2 hepatotoxic drugs (RIF and INH) in patients with CLD or liver cirrhosis and stable liver function [ChildTurcotte-Pugh (CTP) #7], only a single hepatotoxic drug (RIF or INH) in those with advanced liver dysfunction and no hepatotoxic drugs with very advanced liver dysfunction (CTP $11). A standard protocol should be followed for monitoring ATT-related hepatotoxicity and for stop rules and reintroduction rules in all these patients, on the lines proposed here. It is hoped that these proposals will introduce uniformity and result in streamlining the management of these difficult patients. ( J CLIN EXP HEPATOL 2012;2:260-270)

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“…In a study by Fountain FF, et al approximately 60% of the DILI incidence occurred in the first 3 months of treatment, and 80% of the incidence occurred in the first 6 months [34]. Another study showed that DILI has happened after 15-60 days from the date of commencing anti TB therapy [35].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Drug Induced Liver Injury in Tuberculosis and Hepatitis Coinfection by Liver Fibrosis Index Score

Oa¹

2017

Austin J Gastroenterol

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Isoniazid Hepatotoxicity Associated With Treatment of Latent Tuberculosis Infection

Cited by 231 publications

References 16 publications

III Diretrizes para Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia

III Diretrizes para Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia

A Guide to the Management of Tuberculosis in Patients with Chronic Liver Disease

Evaluation of Drug Induced Liver Injury in Tuberculosis and Hepatitis Coinfection by Liver Fibrosis Index Score

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