Anti-Tuberculosis Therapy Induced Liver Injury in Children

Abstract

Introduction: Tuberculosis has remained and is one of the major issues of the under developed world including Pakistan. About 10-11% cases of tuberculosis are from pediatric population. Isoniazid, rifampicin and pyrazinamide constitutes generally used therapeutic regime. Directly observed treatment short course (DOTS) is now much popular strategy. Ant tuberculosis drug-induced liver injury creates obstacles in treatment and also exerts socioeconomic strain on resources. Objective:  To determine the frequency, severity and pattern of the Anti-tuberculosis Drug-Induced Liver Injury in children under 14 years of age. Study Design: Case series study. Duration of Study: 02-10-2015 to 03-10-2016. Setting: Department of Pediatric Medicine Unit-1, Allied Hospital, Faisalabad. Sample size: The total sample size is 100 cases. Sampling Technique: Non-probability purposive sampling. Methodology: Total of 100 patients with either sex from 1 to 15 years of age, on anti-tuberculosis therapy due to any variety of tuberculosis having normal liver anatomy and function initially were studied. Patients already having hepatobiliary disease regardless of etiology were not enrolled in study.  Initial diagnosis was confirmed using set criteria. All patients underwent detailed medical history and physical examination followed by investigations. Data comprising age, sex, type of tuberculosis, treatment interval, and hepatotoxicity etc. was collected using designed Performa by the researcher. The data was analyzed through SPSS-20 by means of descriptive statistic. Results: In our study, out of 100 children, minimum age was 6 months and maximum age was 156 months and Mean + SD was calculated as 38.07±37.368 months, 51 (53.1%) were male and 45 (46.9%) were females, ventilator associated pneumonia was recorded in 19 (19.8%) while 77(80.2%) had no findings of the ventilator associated pneumonia. Conclusion: The frequency of TB DILI was 14.0% in this study, indicating the importance of keeping index of suspicion high for the development of hepatotoxicity with anti-tuberculosis therapy in children being treated for any variety of tuberculosis.