HEPATOTOXICITY OF ATT

Objectives: To determine the frequency of hepatotoxicity with standard ATT. Study design: Descriptive. Setting: Department of Medicine, Combined Military Hospital Lahore. Period: Feb 2007 to April 2008. Materials & methods: 250 patients aged 18 years or greater having pulmonary TB were selected through non-probability convenience sampling technique. All patients were given four drugs for two monthsindoors, followed by two drugs for four months in outdoor. Symptoms suggestive of hepatotoxicity were enquired from the patients regularly. Serum bilirubin and ALT were measured on monthly basis and finally on completion of therapy. Hepatotoxicity was defined as a five fold rise in serum ALT. In patients developing hepatotoxicity, treatment was modified accordingly. Results: This study was done on 189 male and 61female patients (total: 250). Hepatotoxicity developed in 13 (5.2%) patients, mostly during the initial phase of treatment (84.6% incidence during the first month). Risk factors included: age (4 out of 156 young patients and 9 out of 94 older patients; p: 0.016) and nutritional status (8 malnourished patients and 5 well nourished patients; p: 0.031). Hepatotoxicity was not related to the gender (9 males and 4 females; p: 0.585) orthe results of baseline sputum smears (7 out of 102 smear positive cases and six out of 148 smear negative cases; p: 0.064). Conclusions: Hepatotoxicity with ATT is fairly common, especially in the elderly, malnourished patients and during the initial phase of treatment.