NON-STANDARDISED ATT REGIMENS IN DRUG SENSITIVE TB PATIENTS WITH DILI

A number of conditions predispose to anti-TB drugs-induced hepatotoxicity. These include advanced age, female sex, poor nutritional status, preexisting chronic liver disease, extensive pulmonary disease or serious type of tuberculosis e.g. meningitis and high dosages of drugs like Pyrazinamide Tuberculosis treatment in patients with preexisting advanced liver disease poses signicant challenges. The likelihood of druginduced hepatitis is increased with prior advanced liver disease, liver transplant, or hepatitis C infection. Abnormal baseline aminotransferases alone are an independent risk factor for drug induced liver injury , In our study of 79 patients maximum number of patients belonged to age group of 21 to 60, with more males that is 64.3% being affected by DILI. Most of these patients belonged to the lower middle class with majority having lower BMI. 37.3% had history of alcohol intake whereas 31.1% were smokers and 10% had other addictions. .7 percent were patients of disseminated TB, 68.2% were suffering from PTB and 27% had EPTB. 4% had PTB with TB. All these patients showed deranged LFT and their ATT was modied in accordance and the most commonly prescribed non standardised regimen were HRE, E-LEVO, SE-LEVO. At the end of IP phase 57 patients reported improvement, 19 had persisting complains, 1 patient dies and 2 were lost to f/u. Radiological follow up showed that, most patients reported with consolidation at the beginning, out of which 34 reported resolution at end of IP phase. Patients with miliary pattern, effusion and pneumothorax mostly improved radiologically. 2 patients had brotic change. All patients in whom reintroduction of ATT drugs was successfully done , were excluded from the study . It was concluded that the most toxic rst line drug was pyrazinamide and could not be given in patients of DILI. Most of the patients showed improvement at the end of intensive phase. No patient developed any intolerance or reaction to the modied regimen