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Antituberculars/antiepileptic drugs/methotrexate Drug induced hepatitis: 12 case reports

In a study of 515 patients with tuberculosis (TB) treated between January 2007 and December 2017, 12 patients (five boys and seven girls) aged 8 months–15 years, were described who developed drug induced hepatitis during standard anti-tubercular treatment (ATT) with isoniazid, rifampicin, pyrazinamide and ethambutol for TB. Additionally, in four of these 12 patients, treatment with methotrexate, phenytoin or carbamazepine also contributed in the development of hepatitis [routes and durations of treatments to reactions onset not stated; not all dosages stated]. All the patients, who had TB, started receiving standard ATT with isoniazid, rifampicin, pyrazinamide and ethambutol. Five patients received ATT at dosages of isoniazid 5 mg/kg daily, rifampicin 10 mg/kg daily, pyrazinamide 25 mg/kg daily and ethambutol daily, and seven patients received ATT at dosages of isoniazid 10 mg/kg daily, rifampicin 15 mg/kg daily, pyrazinamide 35 mg/kg daily and ethambutol 20 mg/kg daily. Additionally, the patients received treatment with methotrexate (one patient), phenytoin (two patients) and carbamazepine (one patient). Two patients developed hospital acquired sepsis, out of these two patients one had septic shock. Subsequently, all the 12 patients developed hepatitis associated with ATT. In four of these 12 patients, treatment with methotrexate (one patient), phenytoin (two patients) and carbamazepine (one patient) also contributed to the development of hepatitis. In one patient, severe hepatitis resulted in acute liver failure and multi organ failure, and subsequently, the patient was admitted. Thereafter, the hepatitis had recovered in all patients and ATT was discontinued. Later, ATT was restarted in ten of these 12 patients with no recurrence of hepatitis. Eventually, the TB had cured in four patients. Indumathi CK, et al. Revised Antituberculosis Drug Doses and Hepatotoxicity in HIV Negative Children. Indian Journal of Pediatrics 86: 229-232, No. 3, Mar 2019. Available from: URL: http://doi.org/10.1007/s12098-018-2812-z

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Reactions 25 Jan 2020 No. 1788