Hepatotoxicity associated with isoniazid preventive therapy - A 7-year survey from a public health tuberculosis clinic

被引:343
作者
Nolan, CM
Goldberg, SV
Buskin, SE
机构
[1] Univ Washington, Dept Med, Seattle, WA 98195 USA
[2] Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 1999年 / 281卷 / 11期
关键词
D O I
10.1001/jama.281.11.1014
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Isoniazid preventive therapy for latent tuberculosis (TB) infection has been debated because of the risk of hepatotoxicity. The frequency of hepatotoxicity was 0.5% to 2.0% in early studies but may have changed with new criteria for diagnosis and patient selection. Objective To determine the rate of isoniazid hepatotoxicity in patients managed according to current guidelines and practice standards. Design Prospective cohort study. Setting A public health clinic operated by the TB control program of a city-county public health agency. Patients A total of 11 141 consecutive patients who started a regimen of isoniazid preventive therapy for latent TB infection from January 1989 through December 1995, Main Outcome Measures The rate of developing symptoms and signs of hepatotoxicity among all persons starting isoniazid preventive therapy, among all those completing therapy, and by age, sex, and race. Results Eleven patients (0.10% of those starting, and 0.15% of those completing treatment) had hepatotoxic reactions to isoniazid during preventive treatment. The rate of hepatotoxicity in persons receiving preventive therapy increased with increasing age (chi(2) for linear trend = 5.22, P = .02) and there were trends toward increased rates in women (odds ratio [OR], 3.30; 95% confidence interval [CI], 0.87-12.45; chi(2) = 3.28; P = .07) and in whites (OR, 2.60; 95% CI, 0.75-8.95; chi(2) = 3.08; P = .08). Conclusions The rate of isoniazid hepatotoxicity during clinically monitored preventive therapy was lower than has been reported previously. Clinicians should have greater confidence in the safety of isoniazid preventive therapy.
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页码:1014 / 1018
页数:5
相关论文
共 34 条
[1]  
American Thoracic Society, 1965, AM REV RESPIR DIS, V96, P558
[2]   TREATMENT OF TUBERCULOSIS AND TUBERCULOSIS INFECTION IN ADULTS AND CHILDREN [J].
BASS, JB ;
FARER, LS ;
HOPEWELL, PC ;
OBRIEN, R ;
JACOBS, RF ;
RUBEN, F ;
SNIDER, DE ;
THORNTON, G .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1994, 149 (05) :1359-1374
[3]  
BLACK M, 1975, GASTROENTEROLOGY, V69, P289
[4]  
*CDC, 1989, MMWR-MORBID M S, V3, P1
[5]   DECISION-ANALYSIS, PUBLIC-HEALTH POLICY, AND ISONIAZID CHEMOPROPHYLAXIS FOR YOUNG-ADULT TUBERCULIN SKIN REACTORS [J].
COLICE, GL .
ARCHIVES OF INTERNAL MEDICINE, 1990, 150 (12) :2517-2522
[6]   EVALUATING ISONIAZID PREVENTIVE THERAPY - THE NEED FOR MORE DATA [J].
COMSTOCK, GW .
ANNALS OF INTERNAL MEDICINE, 1981, 94 (06) :817-819
[7]   RISK-FACTORS FOR ISONIAZID (INH)-INDUCED LIVER DYSFUNCTION [J].
DICKINSON, DS ;
BAILEY, WC ;
HIRSCHOWITZ, BI ;
SOONG, SJ ;
EIDUS, L ;
HODGKIN, MM .
JOURNAL OF CLINICAL GASTROENTEROLOGY, 1981, 3 (03) :271-279
[8]  
FRANKS AL, 1989, PUBLIC HEALTH REP, V104, P151
[9]  
GARABALDI RA, 1972, AM REV RESPIR DIS, V106, P357
[10]  
GORDIN F, 1998, 5 C RETR OPP INF FEB