Abstract
Aims & Objectives: To study the status of liver functions in patients of multidrug resistant tuberculosis. To asses the prevalence of hepatotoxicity in these patients. To compare and correlate this hepatotoxicity with possible culprit drug/combination and other associated factors. To study the hepatotoxicity of second line antitubercular drugs in patients receiving second line antitubercular drugs..
Material & Methods: This will be a prospective, clinical and epidemiological study of hepatotoxicity in patients of MDR tuberculosis. Consenting individuals will be chosen, cases will be consecutive patients attending various indoor and outdoor facilities of J.A. Group of Hospitals of Gajra Raja Medical College, Gwalior. Those patients who are on treatment with second line antitubercular drugs will be selected for study. Cases will undergo (1) Complete history(2) Clinical evaluation (3) Investigation for the diagnosis of the hepatotoxicity. All the relevant information will be recorded in a pre-designed proforma for the analysis of the result.
Conclusion: It has been observed that the hepatotoxicity which is very common as well as fulminant in patients on treatment with first line antitubercular drugs has not been found even in a single patients second line antitubercular drug inspite of a very long duration of treatment compared to short term chemotherapy even though rifabutin, roxithromycin and azithromycin are known to have their toxic effects on liver.
Keyword: Rifabutin, hepatotoxicity ,Antitubercular
References
- Palomino J C et al. Tuberculosis 2007-From basic science to patient care.
- Flick LF. Development of knowledge of tuberculosis. Philadelphia: Wickersham;1925
- Webb GB. Tuberculosis: Hoeber; 1936
- Rosenblatt MB. Pulmonary tuberculosis: evolution of modern therapy. Bull NY Acad Med 1973;49:163-96
- Rubin SA. Tuberculosis. The captain of all these men of death. Radiol Clin North Am 1995;33:619-39.
- Mangett JJ. Sepulchretum sive natomica practice, vol 1. Observatio XLVII[3 vols]. London: Cramer and Perachon;1700.
- Dubos R, Dubos J. The white plague. Tuberculosis, man and society. Boston: Little, Brown and Company; 1952
- Keers RY. Pulmonary and osseus tuberculosis. A journey down the centuries. London: Bailliere-Tindall; 1978
- World Health Organisation. WHO report 2008. Global tuberculosis control: surveillance, planning, financing. WHO/ HTM/TB/2008.393. Geneva: World Health Organisation;2008
- World Health Organisation. Antituberculosis drug resistance in the world. Report No. 4.. WHO/IUATLD Global Projest on Anti-tuberculosis Drug Resistance Surveillance. WHO/HTM/TB/2008.394. Geneva: World Health Organisation;2008
- Calmette A. Tubercle bacillus infection and tuberculosis in man and animals [ translated by Soper WB, Smith GB]. Baltimore: Williams and Wilkins;1923.
- Benichou C. Criteria for drug-induced liver disorder: report of an international consensus meeting. J Hepatol 1990;11:272–276.
- Chitturi S, Farrell G. Drug-induced liver disease. In: Schiff ER, Sorrell MF, Maddrey WC, editors. Schiff's diseases of the liver, 9th ed. Philadelphia: Lippincott, Williams & Wilkins; 2002. pp. 1059–1128.
- Ostapowicz GM, Fontana R, Schiødt F, Larson A, Davern T, Steven Han H, McCashland T, Shakil A, Hay J, Hynan L, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002;137:947–954.
- Larrey D. Epidemiology and individual susceptibility to adverse drug reactions affecting the liver. Semin Liver Dis 2002;22:145–155.
- Carson JL, Strom BL, Duff A, Gupta A, Das K. Safety of nonsteroidal anti-inflammatory drugs with respect to acute liver disease. Arch Intern Med 1993;153:1331–1336.
- Brown SJ, Desmond PV. Hepatotoxicity of antimicrobial agents. Semin Liver Dis 2002;22:157–167.
- Kaplowitz N. Drug-induced liver injury. Clin Infect Dis 2004;38:S44–S48.
- S. Public Health Service. Hepatic toxicity of pyrazinamide used with isoniazid in tuberculous patients. Am Rev Respir Dis 1969;59:13.
- Kaplowitz N. Biochemical and cellular mechanisms of toxic liver injury. Semin Liver Dis 2002;22:137–144.
- Dufour DR, Lott JA, Nolte FS, Gretch DR, Koff RS, Seeff LB. Diagnosis and monitoring of hepatic injury: I. Performance characteristics of laboratory tests. Clin Chem 2000;46:2027–2049.
- Dufour DR, Lott JA, Nolte FS, Gretch DR, Koff RS, Seeff LB. Diagnosis and monitoring of hepatic injury: II. Recommendations for use of laboratory tests in screening, diagnosis, and monitoring. Clin Chem 2000;46:2050–2068.
- American Gastroenterologic Association Clinical Practice Committee. AGA technical review on the evaluation of liver chemistry tests. Gastroenterology 2002;123:1367–1384.
Corresponding Author
*Dr Ramu Thakur( Assit. Prof.)
MGM Medical College with M.Y. Hospital Indore MP, India
Mob: +919977126168, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i3.107
