Isoniazid liver injury during chemoprophylaxis in children.

Abstract

SUMMARY The incidence of INH-associated liver injury was evaluated in 239 children aged between 9 and 14 years, who were receiving 300 mg INH/day for tuberculosis prophylaxis. Serum SGOT and SGPT levels were determined before INH administration and at 4-weekly intervals thereafter.Levels of both enzymes were raised during the first 3 months of treatment in 18 (7 5 %) children, while in 23 (9.6%) children either SGOT or SGPT exceeded normal levels (SGOT >40 units, SGPT >30 units). Only 2 (0 8 %) children showed SGOT and SGPT values above 100 units and in them treatment with INH had to be discontinued. In all other children transaminases returned to normal during uninterrupted INH administration. It was noted also that transaminase values in children who did not exhibit a rise above normal, still had significantly higher levels during treatment compared with before. The findings of this study suggest that liver injury in children receiving INH for prophylaxis occurs more often than it had hitherto been believed but that it is usually mild and transient.

Elevated transaminases are common in children on prophylactic treatment for tuberculosis

“…We found that a higher percentage of our patients (41%) has elevated transaminase levels at some point during prophylactic treatment for TB than the levels of about 10% reported by most of the other studies . One possible explanation for this difference is that our study employed regular, frequent blood testing throughout therapy.…”

Preventive therapy in children exposed to Mycobacterium tuberculosis: problems and solutions

“…1989) while other studies involving over 2000 children receiving IPT reported no discontinuation of treatment owing to hepatotoxicity (Hsu 1984; Frydenberg & Graham 2009). Any increases in liver transaminase levels in children taking INH are mild, not requiring cessation of treatment (Spyridis et al. 1979).…”

“…Retrospective data from 564 children receiving IPT reported an incidence rate for hepatotoxicity of 0.18%, (Nakajo et al 1989) while other studies involving over 2000 children receiving IPT reported no discontinuation of treatment owing to hepatotoxicity (Hsu 1984;Frydenberg & Graham 2009). Any increases in liver transaminase levels in children taking INH are mild, not requiring cessation of treatment (Spyridis et al 1979). Clinical pyridoxine deficiency is also rarely seen in children (Mcilleron et al 2009).…”

Treatment of Tuberculous Infection and Disease in Children

“…[9,13] In a study of 239 children (aged 9 to 14 years), receiving isoniazid 300 mg/day, 41 children had serum aminotransferase levels above normal during the 12 weeks of therapy. [14] Two of the 41 discontinued isoniazid therapy because aminotransferase levels were greater than 3 times the limit of normal, while the other 39 continued isoniazid without complications. [14] Based on the limited numbers, there does not appear to be any relationship between hepatotoxicity and acetylator status in children.…”

“…[14] Two of the 41 discontinued isoniazid therapy because aminotransferase levels were greater than 3 times the limit of normal, while the other 39 continued isoniazid without complications. [14] Based on the limited numbers, there does not appear to be any relationship between hepatotoxicity and acetylator status in children. [15,16] In asymptomatic children, the routine assessment of laboratory data is unnecessary beyond baseline documentation of normal function.…”