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Hepatic therapy complications revisited of antituberculosis
1983
Summary Since 1973, when the incidence and pattern of adverse reactions to antituberculosis therapy were described by Rossouw and Saunders, para-amino salicylic acid, the majorcause of drug-induced hepa titis, has been withdrawn from the regimen used in Cape Town and replaced with pyrazinamide (PZA). Ourstudy in thesame hospital indicates that although the substitution has resulted in a significant reduc tion in the incidence of all side-effects (4,1% v. 9%; P < 0,001), the incidence of hepatitis is unchanged (0,3%). PZA is currently the major cause of hepatitis associated with antituberculosis therapy. S AIr Med J 1983; 63: 980-963. The published incidence of the hepatic com~lications of antitu berculosis therapy varies from 0,3% to 15%. ,2 This variation is attributed to population differences (including age, genetic varia tion and nutritional status) and to different drug regimens. Before 1975 most South African patients with tuberculosis received para-aminosalicylic acid (PAS) as part of their therapy. In a previous, retrospective study of patients admitted to the City Hospital for Infectious Disease and the Brooklyn Chest Hospital (BCH), Cape Town (1960-1973), Rossouw and Saunders 1 ana lysed the incidence and the clinical and biochemical features of liver disease caused by antituberculosis drugs. PAS (42%) and PAS/isoniazid (INH) (31,5%) accounted for the vast majority of cases. PAS was withdrawn from the antiruberculosis therapeutic regimen used in Cape Town in 1975. In anticipation that with drawal of PAS would have decreased the overall incidence of hepatic complications of therapy, we studied the records of5 565 patients seen in the BCH over the past 5 years, using the same methodology as Rossouw and Saunders. ' While the incidence of non-hepatic complications of antituberculosis therapy has decreased from 9% to 4, 1% (P
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