Hepatitis

• When the levels noted above are reached, stop all drugs until biochemical abnormalities are stabilized, then reintroduce drugs one at a time.


• The drugs should be reintroduced starting with the one least likely to be the causative agent, (Reintroduce R and E together first, and wait 3 days, if liver function tests are normal then reintroduce H.)


• If abnormalities have not recurred then Z has been identified as the causative agent and it should not be reintroduced.


• In addition to elevation of the AST and ALT, occasionally there are disproportionate increases in bilirubin and alkaline phosphatase. This pattern is more consistent with rifampin hepatotoxicity. Z is the most common causative agent of hepatotoxicity during treatment with first-line anti-TB medications.