Analysis of Hepatotoxic Reactions During Treatment of Newly Diagnosed Patients with Pulmonary Drug Resistant Tuberculosis

Abstract

216 newly detected pulmonary tuberculosis patients suffring from multiple drug resistance (MDR) were examined. The patients were divided into 2 groups. The fist group consisted of 164 patients in whom when admitted to hospital, GeneXpert MTB/RIF was used to test the resistance of Mycobacterium tuberculosis (MTB) to rifampicin. Initially, patients in this group were treated with chemotherapy regimen 4 (pyrazinamide, kanamycin/amikacin/capreomycin, floroquinolones, cycloserine/terizidone, prothionamide, PAS). Group 2 included 97 patients. They all were treated with chemotherapy regimen 1 (isoniazid, rifampicin, pyrazinamide, ethambutol/streptomycin) before MDR was confimed in them by sputum culture on solid media (in 2-3 months of treatment) after that treatment regimen was amended with re-registration for chemotherapy regimen 4. It was found out that hepatotoxic reactions in patients without initial abnormal liver function when prescribing chemotherapy regimen 4 occurred in 31.3% of cases and when initially using regimen 1 followed by switching to regimen 4 – in 87.8% of cases ( p < 0.001). In the course of treatment, the signs of liver damage in patients who initially received regimen 4 were more frequent in the fist 2 months of treatment, whereas in patients treated initially with regimen 1 with subsequent switching to regimen 4 – during the fist 4 months. In the overwhelming majority of cases, hepatotoxic reactions were mild in patients who initially received regimen 4 as well as in patients initially treated with regimen 1 followed by switching to regimen 4. However, severe hepatotoxic reactions were more often observed in patients from Group 2.