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Free Content Drug-related hepatitis in patients treated with standard anti-tuberculosis chemotherapy over a 30-year period

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SETTING: Drug-induced hepatitis is known to occur in a proportion of patients on treatment for active tuberculosis (TB).

DESIGN: We prospectively examined the incidence of drug-induced hepatitis in 2070 patients treated for TB with the standard regimen based on 6 months of rifampicin (R, RMP) and isoniazid (H, INH), with 2 months of initial pyrazinamide (Z, PZA) and ethambutol (E, EMB), over a 30-year period from 1981 to 2010, in Blackburn, UK.

RESULTS: Of the 1031 (49.8%) males and 1039 (50.2%) females studied, 451 (21.8%) were White and 1585 (76.6%) were of South Asian origin. Only 34 (1.6%) were of African or other origins. Of the total number of patients treated, 63 (3.0%) had drug-related hepatitis, 26 (5.8%) of whom were White, 37 (2.33%) Asians and 0 other. Incidence was significantly higher in Whites than Asians (OR 2.13, P = 0.008). Incidence increased with increasing age (OR 1.16, P = 0.02). The presumed causative drug was PZA 57%, RMP 32%, INH 11%, EMB 0%. There was no trend of increased hepatitis rates over time.

CONCLUSION: Rates of drug-induced hepatitis where change of treatment is required are low in patients treated with standard RHZE-based therapy (3%). Caucasians and older patients were more likely to develop hepatitis than their counterparts.
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Keywords: drug side effects; tuberculosis

Document Type: Research Article

Affiliations: 1: Department of Respiratory Medicine, University Hospital South Manchester, Manchester, UK; Institute of Inflammation and Repair, University of Manchester, Manchester, UK 2: Chest Clinic, Royal Blackburn Hospital, Haslingden Road, Blackburn, UK 3: Department of Medical Statistics, University Hospital of South Manchester, Manchester, UK 4: Institute of Inflammation and Repair, University of Manchester, Manchester, UK; Chest Clinic, Royal Blackburn Hospital, Haslingden Road, Blackburn, UK; Lancashire Postgraduate School of Medicine and Health, University of Central Lancashire, Preston, Lancashire, UK

Publication date: December 1, 2016

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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