Reintroduction regimens in anti-tubercular therapy-induced hepatitis in extra-pulmonary tuberculosis patients – A pilot study

Abstract Background Anti-tubercular therapy-induced hepatotoxicity (AIH) is associated with a significant mortality. Reintroduction of anti-tuberculosis drugs in patients with AIH has never been studied systematically. The present study was planned to see the best reintroduction regimen in patients of AIH. Methods The trial was conducted on 32 patients (divided into three groups) of extra-pulmonary tuberculosis who developed AIH. In group 1 – Isoniazid (INH) and Rifampicin (RIF) were given from day 1. In group 2 – RIF was given from day 1 and INH from day 8. In group 3 – INH was given from day 1 and RIF from day 8. Pyrazinamide was added when above regimens were tolerated. Results The incidence was found to be highest in patients with tubercular meningitis (41%) followed by abdominal, pericardial, disseminated, spinal, and lymph nodes. In the study, 21% patients had recurrence of AIH with majority of patients having tolerated the reintroduction of drugs. The success rate of group 1 came out to be 60%, 72.72% in group 2 and 100% in group 3. Conclusion The recurrence rate of hepatotoxicity was statistically insignificant between the three groups ( p  u003e 0.05), and thus all three hepatotoxic drugs can be reintroduced safely in patients developing AIH.