Anti-tuberculosis drug-induced hepatitis

In 1996 a six-month short-course chemotherapy was adopted as a standard chemotherapy for pulmonary tuberculosis in Japan. The frequency of implementation of short course chemotherapy for smear positive new case was only sixty percent in 2003, although a short course chemotherapy was recommended all over the world for avoidance of acquiring a new resistance among new drug resistant tuberculosis. The reasons for the low adaptation of short course chemotherapy were speculated that high rate of elderly patients, and high frequency of drug-induced hepatitis. From our 14-year experience, the frequency of drug-induced hepatitis was 7.8% for all patients with standard 6-month or 9-month regimen, 7.2% in the patients with normal liver function tests at the start of chemotherapy, and 11.8% in the patients with any kinds of abnormality. The death rate was 0.04% among treated patients, and fatality was 0.49% among the patients with drug-induced hepatitis. Positive HCV antibody and less than 1,000 cells/microL of peripheral lymphocyte count at the beginning of treatment were independent risk factors for drug-induced hepatitis. The management of hepatitis during antituberculosis treatment was also referred.