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Choi, Park, Hong, Oh, Lim, Lee, Koh, Kim, Kim, Kim, and Shim: Hepatotoxicity of Rifampicin and Pyrazinamide Treatment Excluding Isoniazid
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2006; 60(1): 38-43.

Published online: 31 January 2006

DOI: https://doi.org/10.4046/trd.2006.60.1.38

Hepatotoxicity of Rifampicin and Pyrazinamide Treatment Excluding Isoniazid

Ik Su Choi, M.D., I-Nae Park, M.D., Sang-Bum Hong, M.D., Yeon-Mok Oh, M.D., Chae-Man Lim, M.D., Sang Do Lee, M.D., Younsuck Koh, M.D., Woo Sung Kim, M.D., Dong Soon Kim, M.D., Won Dong Kim, M.D., Tae Sun Shim, M.D.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Address for correspondence: Tae Sun Shim, M.D., Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3892, Fax: 82-2-3010-6968, shimts@amc.seoul.kr

Received 12 October 2005       Accepted 5 December 2005

Copyright © 2006 The Korean Academy of Tuberculosis and Respiratory Diseases

Abstract

Background

Even though two-month rifampicin (RMP, R) and pyrazinamide (PZA, P) treatment has some advantages over isoniazid (INH, H) treatment for latent tuberculosis infection (LTBI), it was withdrawn from the list of treatment regimens for LTBI because of reported cases of severe hepatotoxicity. The purpose of this study was to estimate the frequency of hepatotoxicity of RMP and PZA treatment excluding INH in a Korean population.

Method

TIn order to recruit patients who were prescribed RMP and PZA excluding INH, 256 INH-resistant tuberculosis patients were investigated through retrospective medical record analysis. A standard four-drug regimen was changed to a RMP/PZA-containing regimen excluding INH in 64 patients (RZ+ group). In the same study period, 146 patients who were prescribed an INH/RMP/PZA-containing standard regimen were randomly selected as a control (HRZ+ group). Clinical characteristics including liver diseases and the frequency of drug-induced hepatitis were compared between the RZ+ and HRZ+ groups.

Result

The mean age of patients in the RZ+ group was 50.2 (±16.2) and the male-to-female ratio was 36:28. The frequency of underlying liver diseases was 10.9% (7/64), which was not significantly different from that of the HRZ+ group (4.1%, 6/146). Even though the treatment duration of RZ+ (5.5 ± 4.8 months) was longer that than that of HRZ+ (2.7 ± 2.3 months), the frequency of toxic hepatitis was not significantly different between RZ+ and HRZ+ groups, 3.5% (2/57) and 7.1% (10/140), respectively.

Conclusion

Hepatotoxicity was mild and occurred in a minor proportion of patients in a Korean population prescribed an RMP/PZA-containing regimen. A future prospective study including more patients is needed.

Keywords: Tuberculosis, Latenet tuberculosis infection, Rifampicin, Pyrazinamide, Hepatotoxicity

Figures and Tables

Table 1
Comparison of clinical characteristics between RZ+ and HRZ+ groups.
trd-60-38-i001

1Underlying liver diseases include liver diseases (n=5) and hepatotoxicity occurred by preceding treatment (n=2).

2Duration of treatment means the duration of treatment using a RMP/PZA-containing regimen and an INH/RMP/PZA-containing regimen, respectively. In case of HRZ+ group, initial four-drug regimen usually continued for 2 months and then was swithched to 3-drug regimen containing INH/RMP/EMB.

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