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Antituberculous therapy induced hepatitis in children treatment plan

Among the first line antitubercular drugs isoniazid pyrazinamide rifampicin can cause he Pathak damage and the resultant drug induced hepatitis

Before embarking on the diagnosis of antituberculous therapy induced hepatitis one must rule out the possibility of other causes of hepatitis

The management of antituberculous therapy hepatitis depends upon whether the patient has severe liver disease or what is the severity of Tuberculosis or what is the capacity of health unit to manage the side effects of TB treatment

If it is really thought that hepatic damage is due to antituberculous therapy all antitubercular drugs should be stopped and the patient is put on a non hepatotoxic regimen consisting of streptomycin ethambutol a fluoroquinolone

Now if liver function test are available it is advised to wait till the tests normalise along with the clinical symptoms resolution before Re introduction of antituberculous therapy or if liver function tests are not available then wait two weeks extra till jaundice resolves

If the criteria in the above paragraph is not fulfilled continued non hepatotoxic drugs regimen of streptomycin ethambutol and fluoroquinolone for a total of 18 to 24 months

In case the antituberculous therapy induced hepatitis has resolved drugs are introduced one at a time such that keen observation is given to recurrence of symptoms drugs are added one drug at a time and if jaundice wreckers the last drug added should be stopped

Since rifampicin is thought to be the least hepatotoxic experts advice adding rifampicin first during the Wii introduction of antituberculous therapy

Once patient has tolerated 7 days of rifampicin isoniazid may be added

Sometimes it is advisable to avoid adding pyrazinamide as it is most hepatotoxic antitubercular drug

Among the cause of Jaundice for hepatitis if rifampicin is found to be the causative agent then is selected without rifampicin with 2 months of isoniazid ethambutol and streptomycin followed by 10 months of isoniazid and ethambutol

If the causative agent is isoniazid then 9 months of rifampicin pyrazinamide and ethambutol be considered this duration may be reduced to 6 months depending upon disease severity

If the causative agent is pyramid the total duration of isoniazid and rifampicin therapy may be extended to 9 months

If isoniazid know rifampicin can be used we have to select the non hepatotoxic regimen consisting of streptomycin ethambutol and fluoroquinolone and these have to be continued for 24 months

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