Study of Hepatotoxicity During Antitubercular Therapy in Children
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 12
Abstract
Abstract: All pharmacological interventions balance efficacy and toxicity; there are few efficacious agents that do not have some toxicity risk. In the case of antituberculosis agents the major risk is hepatotoxicity and three agents identified by World Health Organization (WHO) as essential, isoniazid (INH), rifampicin (RMP) and pyrazinamide (PZA), carry such a risk. The liver is vulnerable to injury from the first line anti-tuberculosis drugs. This may result in mortality, long term morbidity and reduced compliance to therapy. A prospective study of 100 cases was done in this study. The cases were divided into two broad groups. Group A comprised control of 25 children and Group B comprised different varieties of tuberculosis patient with 75 children. Serial estimations of SGPT and alkaline phosphatase were undertaken at the beginning of therapy and at 1st, 2nd, 3rd, 4th, 5th, 6h, 8th, 10th and 12th weeks of antitubercular therapy. Out of 75 patients studied 49 cases were male (65.3%) and rest were female (34.7%). Out of 75 patients examined, 33.3% had primary complex and 20% tuberculous pneumonia, 5.4% lymphadenopathy, and 4% had Koch’s abdomen. In group I none developed hepatomegaly and jaundice; while in Gr. II 2 patients (6.2%) and Gr. III 3 patients (11%) had developed clinical jaundice and hepatomegaly. The highest incidence of hepatic dysfunction in 2m-1 yr of age group 42.8% followed by 31.25% in 1-3yrs age group, 37.03% in 3-6 yrs and 285 in 6-12 yrs age group. There was no symptomatic case of hepatic dysfunction in 1st 2 weeks. Between 2-5 wks after initiation of ATT only 2 patients had symptomatic liver dysfunction. After 5 wks of starting treatment 3 patients had developed symptomatic hepatic dysfunction. Overall hepatotoxicity in our study was 33.33%. Maximum toxicity occurred after only 2 weeks of ATT. There was inverse correlation of toxicity with the age of patient. There was direct correlation of severity of malnutrition to toxicity of ATT in the study cases.
Authors and Affiliations
Dr. Sushil Kumar, Dr. Chand Miyan Kamaal, Dr. Mohd. Anjoom, Dr. Neetu Goyal
Keywords
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