Comparison of British Thoracic Society and American Thoracic Society reintroduction guidelines for anti-tuberculous therapy induced liver injury.

Abstract

OBJECTIVE:

To compare the efficacy of British Thoracic Society and American Thoracic Society guidelines for reintroduction of anti-tuberculous therapy after drug-induced liver injury, and to assess the ease of administration of each guideline on a scale of 1-10.

METHODS:

The randomised prospective interventional study was conducted at the Department of Medicine and Pulmonology, Dow University of Health Sciences, Karachi, from December 2011 to November 2013. Patients with anti-tuberculous therapy drug-induced liver injury were selected. Hepatotoxic anti-tuberculous therapy was stopped and modified anti-tuberculous therapy was started. Patients were followed weekly till clinical and biochemical parameters got stabilised. After stabilisation, the patients were randomised to one of the two groups to receive re-introduction of anti-tuberculous therapy under the guidelines of British Thoracic Society (Group I) or those of American Thoracic Society (Group II). Means of the groups were analysed by Student's t test and proportions were compared by chi-square test. Multivariate analysis was done for age, body mass index and serum albumin for recurrence of drug-induced liver injury after the re-introduction. P value < 0.05 was taken as significant.

RESULTS:

Of the total 325 patients, 163 (50.15%) were in Group I, while 162 (49.84%) were in Group II. The frequency of recurrence of drug-induced liver injury in Group I was 16 (9.8%) and in Group II it was 18 (11.1%).There was no statistically significant difference between the two groups (p < 0.7). Age was positively related with drug-induced liver injury, while body mass index and serum albumin were negatively associated.

CONCLUSION:

There was no significant difference between the two major guidelines though the American Thoracic Society guideline was easier to follow.

• Authors: Bader Faiyaz Zuberi, Faisal Faiyaz Zuberi, Nimrah Bader, Haris Alvi, Javeria Salahuddin
• Journal: JPMA. The Journal of the Pakistan Medical Association (J Pak Med Assoc) Vol. 64 Issue 8 Pg. 896-9 (Aug 2014) ISSN: 0030-9982 [Print] Pakistan
• PMID: 25252514 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Antitubercular Agents

Topics

• Antitubercular Agents (administration & dosage, adverse effects)
• Chemical and Drug Induced Liver Injury (etiology, prevention & control)
• Female
• Humans
• Male
• Middle Aged
• Pakistan
• Practice Guidelines as Topic
• Prospective Studies
• Societies, Medical
• United Kingdom
• United States