Tuberculosis and hepatic toxicity in children

Abstract

Morbidity and mortality from tuberculosis (TB) has fallen dramatically in the past half century due, in large part, to the introduction of effective anti-TB medications. Isoniazid remains the drug of choice for children with either latent or active TB infection; active disease is also treated with two or more additional drugs, usually including rifampin and pyrazinamide. However, while effective, these drugs also carry known risks for hepatotoxicity and may lead to both asymptomatic liver injury and clinically overt hepatitis. Current guidelines encourage regular clinical follow-up and selective laboratory monitoring, yet liver failure still occurs in a rare minority of cases. This review outlines the recommendations for treatment of childhood TB, the risks of drug-induced hepatic toxicity in these children and the strategies that are both in use and under development that aim to reduce this risk.