Assessing the Hepatotoxic Effects of Anti-Tuberculosis Treatment in Multi-Drug-Resistant Patients: Evidence from Fatimah Jinnah Hospital, Quetta

Essa Muhammad; Gull Andam; Noman Haq; Muhammad Saleem; Kaleem Ullah; Dawood Ahmed Babar; Muhammad Afzal; Sara Jafar

doi:10.70749/ijbr.v3i5.1396

Authors

Essa Muhammad Department of Neurology, BMC Hospital, Quetta, Balochistan, Pakistan.
Gull Andam Medical Unit 4, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
Noman Haq Faculty of Pharmacy and Health Sciences, University of Balochistan, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
Muhammad Saleem Aria Institute of Medical and Health Sciences, Quetta, Balochistan, Pakistan.
Kaleem Ullah Medical Unit 4, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
Dawood Ahmed Babar Medical Unit 4, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
Muhammad Afzal Medical Unit 4, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.
Sara Jafar Medical Unit 4, Sandeman Provincial Hospital, Quetta, Balochistan, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i5.1396

Keywords:

Hepatotoxicity, Multi-drug-Resistant Tuberculosis, Adverse Drug Reactions, INR, Resource-limited Settings

Abstract

Background: Hepatotoxicity continues to be a significant side effect of second-line anti-tuberculosis therapy, especially in patients with multidrug-resistant tuberculosis. Resource-constrained environments encounter increased difficulties owing to restricted monitoring and management capabilities. Methods: A retrospective cohort study was performed at Fatimah Jinnah Chest Hospital, encompassing 200 MDR-TB patients. Hepatotoxicity was characterised by alanine/aspartate transaminase values above three times the upper limit of normal. Statistical analyses encompassed t-tests, chi-square tests, and multivariable logistic regression to ascertain risk factors. Results: The incidence of hepatotoxicity was 12%. Patients with hepatotoxicity were older (mean age 45.5 vs. 37.8 years, p=0.041) and demonstrated significantly increased INR (1.50±0.30 vs. 0.76±0.25, p<0.001). Resistance patterns affected risk, with non-MDR strains (poly/XDR/Xpert-resistant) linked to increased risks (OR=5.61, 95% CI:0.40–77.98; p=0.014). Multivariable analysis identified INR as the most significant predictor (adjusted OR=395.7 per 1-unit rise; 95% CI:46.5–3366.8; p<0.001). Treatment outcomes were positive (82.5% cured), while adverse medication reactions were common, including gastritis (9.0%) and arthralgia (6.0%). Conclusion: Hepatotoxicity is common among MDR-TB patients undergoing second-line treatments, with increased INR and certain resistance types identified as significant risk factors. These findings highlight the imperative for stringent liver function surveillance and customised therapeutic approaches in high-burden environments to reduce hepatotoxic hazards and enhance treatment compliance. Improved pharmacovigilance and prompt intervention methods are essential for optimising MDR-TB management in resource-limited settings.

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