Short-Course Treatment for TB May Increase Liver Injury

زائر
The standad theapy in patients with atent tbesis, defined as a psitive tbein skin test witht evidene f ative tbesis, is isniazid f at east six mnths. Hweve, bease f ptentia txiity, espeiay hepatitis, and p adheene t the mediatin egimen, a shte tw-mnth se f pyazinamide and ifampin has been sggested f teatment f atent tbesis in patients with hman immndefiieny vis (HIV) infetin. Gideines fm the entes f Disease nt and Peventin and the Ameian Thai Siety inde thee hies f the management f atent tbesis: (1) isniazid f six t nine mnths, (2) ifampin f f mnths, (3) ifampin and pyazinamide f tw mnths. Hweve, ases f sevee ive txiity have been nted with the tw-dg egimen. Jasme and assiates ndted a mtiente, pspetive, pen-abe tia t mpae the txiity and theapy adheene f the tw-mnth egimen f ifampin and pyazinamide with the six-mnth egimen f isniazid in pesns with atent tbesis bt n HIV infetin.
Patients wh wee at east 17 yeas f age and wh wd dinaiy be teated f atent tbesis wee inded in the stdy. Exsin iteia inded pegnany, HIV infetin, eevated eatinine eves ive enzyme test ests, and a histy f gt. Patiipants wee divided int tw gps, eeiving eithe ifampin (600 mg daiy) and pyazinamide (20 mg pe kg daiy) f tw mnths (307 patients) isniazid (300 mg daiy) f six mnths (282 patients). Sem eves f ive enzymes and biibin wee meased afte ne mnth and again at thee mnths in the patients eeiving isniazid. Patients eeiving the tw-dg egimen as had a mpete bd nt and measement f i aid and eatinine eves afte ne mnth f teatment.
In patients with ive fntin test ests geate than five times nma (gade 3 hepattxiity n the Wd Heath ganizatin [WH] assifiatin), teatment with stdy mediatins was stpped ness sme the ase f eevated ive enzymes, sh as ah abse, d be fnd. In patients with ive fntin test ests geate than 10 times nma (gade 4 hepattxiity n the WH assifiatin), the teatment egimen was disntined pemanenty.
Amng patiipants having ive enzyme tests, hepattxiity deveped me feqenty in thse eeiving the ifampin-pyazinamide egimen (26 peent) than in thse eeiving isniazid (16 peent). The ifampin-pyazinamide egimen was signifianty me ikey t be disntined bease f hepattxiity. the advese events ed eqay amng the tw gps, exept f skin ash, whih was signifianty me mmn amng the patients eeiving the ifampin-pyazinamide egimen. Teatment mpetin was simia amng the tw gps.
The aths nde that the sht-se teatment f atent tbesis sing pyazinamide and ifampin is assiated with a highe isk f hepattxiity mpaed with the six-mnth se f isniazid in adts witht HIV infetin. The sht-se, tw-dg egimen shd be sed atisy and with eay ive-injy evaatin t deease the pssibiity f sevee ive txiity.
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Dr.isra

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