Comparison and outcome of various methods of reinstitution of anti-tubercular drugs in post drug induced hepatitis patients.

Background : Hepatotoxicity is one of the side effects of anti-tubercular therapy (ATT). After the development of drug induced hepatitis, ATT can be reintroduced by different methods. Aim of this study was comparison and outcome of various methods of reinstitution of anti-tubercular drugs in post anti-tubercular drug induced hepatitis. Objectives : To compare the efficacy of 3 different reintroduction regimens (WHO,ATS and BTS ) of anti-tubercular drugs after development of anti-tuberculosis treatment induced hepatotoxicity. Participants : Patients of either age and sex were recruited in this study. Study design : This study was conducted prospectively at SKIMS.The study period was 2018-2021. Methods : A total of 103 patients with diagnosis of ATT induced hepatitis were randomized to receive one of the three reintroduction regimens. In Arm-I, ATT was restarted as per WHO guidelines. In Arm-II and Arm-III , ATT was restarted as per ATS and BTS guidelines respectively. Results : Total 18 (18.4% ) patients had recurrence.5 (15.2%) patients in Arm-I, 6 (18.2%) patients in Arm-II and 7 (21.9%) patients in Arm-III. p value >0.05.Of all the clinical and lab parameters ,LFT at the time of first episode of hepatitis was only statistically significant parameter for recurrence of hepatitis. Conclusion : There was no statistical significance for recurrence of ATT induced hepatitis in all the three groups.ATT can be restarted simultaneously at full dosage from Day 1 according to WHO guidelines which has many advantages of cost effectiveness ,less chances of reactivation and resistance ,decreased rate of infectivity in extensive pulmonary tuberculosis. Sequential reintroduction causes prolonged days of admission and increased chances of morbidity and poor followup of these patients.