Antituberculosis drug-induced hepatotoxicity: Concise up-to-date review
The cornerstone of tuberculosis management is a 6‐month course of isoniazid, rifampicin, pyrazinamide and ethambutol. Compliance is crucial for curing tuberculosis. Adverse effects often negatively affect the compliance, because they frequently require a change of treatment, which may have negative...
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| Published in | Journal of gastroenterology and hepatology Vol. 23; no. 2; pp. 192 - 202 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Melbourne, Australia
Blackwell Publishing Asia
01.02.2008
Blackwell Science |
| Subjects | |
| Online Access | Get full text |
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| Abstract | The cornerstone of tuberculosis management is a 6‐month course of isoniazid, rifampicin, pyrazinamide and ethambutol. Compliance is crucial for curing tuberculosis. Adverse effects often negatively affect the compliance, because they frequently require a change of treatment, which may have negative consequences for treatment outcome. In this paper we review the incidence, pathology and clinical features of antituberculosis drug‐induced hepatotoxicity, discuss the metabolism and mechanisms of toxicity of isoniazid, rifampicin and pyrazinamide, and describe risk factors and management of antituberculosis drug‐induced hepatotoxicity. The reported incidence of antituberculosis drug‐induced hepatotoxicity, the most serious and potentially fatal adverse reaction, varies between 2% and 28%. Risk factors are advanced age, female sex, slow acetylator status, malnutrition, HIV and pre‐existent liver disease. Still, it is difficult to predict what patient will develop hepatotoxicity during tuberculosis treatment. The exact mechanism of antituberculosis drug‐induced hepatotoxicity is unknown, but toxic metabolites are suggested to play a crucial role in the development, at least in the case of isoniazid. Priorities for future studies include basic studies to elucidate the mechanism of antituberculosis drug‐induced hepatotoxicity, genetic risk factor studies and the development of shorter and safer tuberculosis drug regimens. |
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| AbstractList | The cornerstone of tuberculosis management is a 6-month course of isoniazid, rifampicin, pyrazinamide and ethambutol. Compliance is crucial for curing tuberculosis. Adverse effects often negatively affect the compliance, because they frequently require a change of treatment, which may have negative consequences for treatment outcome. In this paper we review the incidence, pathology and clinical features of antituberculosis drug-induced hepatotoxicity, discuss the metabolism and mechanisms of toxicity of isoniazid, rifampicin and pyrazinamide, and describe risk factors and management of antituberculosis drug-induced hepatotoxicity. The reported incidence of antituberculosis drug-induced hepatotoxicity, the most serious and potentially fatal adverse reaction, varies between 2% and 28%. Risk factors are advanced age, female sex, slow acetylator status, malnutrition, HIV and pre-existent liver disease. Still, it is difficult to predict what patient will develop hepatotoxicity during tuberculosis treatment. The exact mechanism of antituberculosis drug-induced hepatotoxicity is unknown, but toxic metabolites are suggested to play a crucial role in the development, at least in the case of isoniazid. Priorities for future studies include basic studies to elucidate the mechanism of antituberculosis drug-induced hepatotoxicity, genetic risk factor studies and the development of shorter and safer tuberculosis drug regimens. Abstract The cornerstone of tuberculosis management is a 6‐month course of isoniazid, rifampicin, pyrazinamide and ethambutol. Compliance is crucial for curing tuberculosis. Adverse effects often negatively affect the compliance, because they frequently require a change of treatment, which may have negative consequences for treatment outcome. In this paper we review the incidence, pathology and clinical features of antituberculosis drug‐induced hepatotoxicity, discuss the metabolism and mechanisms of toxicity of isoniazid, rifampicin and pyrazinamide, and describe risk factors and management of antituberculosis drug‐induced hepatotoxicity. The reported incidence of antituberculosis drug‐induced hepatotoxicity, the most serious and potentially fatal adverse reaction, varies between 2% and 28%. Risk factors are advanced age, female sex, slow acetylator status, malnutrition, HIV and pre‐existent liver disease. Still, it is difficult to predict what patient will develop hepatotoxicity during tuberculosis treatment. The exact mechanism of antituberculosis drug‐induced hepatotoxicity is unknown, but toxic metabolites are suggested to play a crucial role in the development, at least in the case of isoniazid. Priorities for future studies include basic studies to elucidate the mechanism of antituberculosis drug‐induced hepatotoxicity, genetic risk factor studies and the development of shorter and safer tuberculosis drug regimens. |
| Author | Aarnoutse, Rob E Van Der Ven, Andre J A M Boeree, Martin J Dekhuijzen, Richard Tostmann, Alma De Lange, Wiel C M |
| Author_xml | – sequence: 1 givenname: Alma surname: Tostmann fullname: Tostmann, Alma email: a.tostmann@ulc.umcn.nl organization: Department of Pulmonary Diseases – sequence: 2 givenname: Martin J surname: Boeree fullname: Boeree, Martin J organization: Department of Pulmonary Diseases – sequence: 3 givenname: Rob E surname: Aarnoutse fullname: Aarnoutse, Rob E organization: Clinical Pharmacy and – sequence: 4 givenname: Wiel C M surname: De Lange fullname: De Lange, Wiel C M organization: University Lung Center Dekkerswald, Departments of – sequence: 5 givenname: Andre J A M surname: Van Der Ven fullname: Van Der Ven, Andre J A M organization: Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands – sequence: 6 givenname: Richard surname: Dekhuijzen fullname: Dekhuijzen, Richard organization: Department of Pulmonary Diseases |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20126610$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/17995946$$D View this record in MEDLINE/PubMed |
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| Keywords | Toxicity toxic hepatitis Hepatic disease hydrazine Review Rifamycin Pyrazinamide Hepatitis Antibiotic Rifampicin Treatment adverse effect antituberculous treatment drug-induced hepatitis rifampin Digestive diseases Antituberculous agent antitubercular agents Protein synthesis inhibitor Antibacterial agent Hepatotoxicity Isoniazid Bibliographic review |
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| Snippet | The cornerstone of tuberculosis management is a 6‐month course of isoniazid, rifampicin, pyrazinamide and ethambutol. Compliance is crucial for curing... The cornerstone of tuberculosis management is a 6-month course of isoniazid, rifampicin, pyrazinamide and ethambutol. Compliance is crucial for curing... Abstract The cornerstone of tuberculosis management is a 6‐month course of isoniazid, rifampicin, pyrazinamide and ethambutol. Compliance is crucial for curing... |
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| SubjectTerms | adverse effect Antibacterial agents Antibiotics. Antiinfectious agents. Antiparasitic agents antitubercular agents Antitubercular Agents - adverse effects antituberculous treatment Biological and medical sciences Chemical and Drug Induced Liver Injury Drug Therapy, Combination Drug toxicity and drugs side effects treatment drug-induced hepatitis Gastroenterology. Liver. Pancreas. Abdomen Humans hydrazine Incidence isoniazid Isoniazid - adverse effects Liver Diseases - pathology Liver Diseases - physiopathology Liver Diseases - therapy Liver. Biliary tract. Portal circulation. Exocrine pancreas Medical sciences Other diseases. Semiology Pharmacology. Drug treatments pyrazinamide Pyrazinamide - adverse effects rifampicin rifampin Rifampin - adverse effects Risk Factors toxic hepatitis Toxicity: digestive system Tuberculosis - drug therapy |
| Title | Antituberculosis drug-induced hepatotoxicity: Concise up-to-date review |
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