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Antituberculosis drug‐induced hepatotoxicity: Concise up‐to‐date review

Open access
Tostmann, Alma, Boeree, Martin J, Aarnoutse, Rob E, De Lange, Wiel C M, Van Der Ven, Andre J A M, Dekhuijzen, Richard·2008·Journal of Gastroenterology and Hepatology

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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Crossref · 10.1111/j.1440-1746.2007.05207.x

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Metadata

Authors
Tostmann, A., Boeree, M. J., Aarnoutse, R. E., De Lange, W. C. M., Van Der Ven, A. J. A. M., & Dekhuijzen, R.
Venue
Journal of Gastroenterology and Hepatology
Publisher
Wiley
Published
2007-11-07
Volume
23
Issue
2
Pages
192-202
ISSN
  • 0815-9319 (ISSN-L)
  • 1440-1746
OpenAlex
W2020976497
Cited by
781
References
2
FWCI
14.74
Type
journal article
Language
en
Open access
bronze

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