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Letters |1 March 1994

Special Problems in Treating Tuberculosis

Nadim Salomon, MD; David C. Perlman, MD; Susan Goldstein, MD

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  • Beth Israel Medical Center; New York, NY 10003
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TO THE EDITOR:
Barnes and Barrows [1] suggest that a regimen of ethambutol, ofloxacin, and an aminoglycoside can be used when antituberculous medication-induced hepatotoxicity occurs. We have recently reviewed our experience with this approach in 14 patients infected with the human immunodeficiency virus (HIV) (median CD4+ cell count, 39 cells/mm3) who had developed symptomatic liver disease while receiving regimens containing isoniazid, rifampin, and pyrazinamide for active tuberculosis [2]. In 13 patients (93%), liver test abnormalities occurred within the first 2 months of treatment. All had severe hepatotoxicity manifested by abdominal pain (71%), vomiting (50%), jaundice (57%), and encephalopathy (21%), with mean elevations of the aspartate aminotransferase and total bilirubin levels to 9.2 and 6.2 times the upper limits of normal, respectively.
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Salomon N, Perlman DC, Goldstein S. Special Problems in Treating Tuberculosis. Ann Intern Med. 1994;120:440–441. doi: 10.7326/0003-4819-120-5-199403010-00026

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Published: Ann Intern Med. 1994;120(5):440-441.

DOI: 10.7326/0003-4819-120-5-199403010-00026

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