From the Guidelines
For a patient with latent tuberculosis and high liver function tests (LFTs), the recommended treatment is often adjusted to minimize further liver injury.
Treatment Options
- The preferred treatment option is usually Rifabutin (300 mg daily) for 4 months, as it is considered to be less hepatotoxic compared to other anti-tuberculosis medications 1.
- Alternatively, if Rifabutin is not tolerated or available, Isoniazid (300 mg daily) with pyridoxine (50 mg daily) supplementation can be considered, but with close monitoring of LFTs every 2-4 weeks 1. The duration of Isoniazid treatment is typically 6-9 months.
Monitoring and Adjustments
It is essential to monitor LFTs regularly and adjust the treatment regimen as needed to prevent further liver damage 1. In some cases, treatment may need to be interrupted or discontinued if LFTs become significantly elevated.
Considerations
It's crucial to weigh the benefits and risks of treatment and consider the individual patient's condition and medical history when making treatment decisions. Patients with a history of liver injury or excessive alcohol consumption should be treated with caution, and baseline and follow-up monitoring of serum aminotransaminases are recommended 1.
From the FDA Drug Label
Although there have not been the same kinds of carefully conducted controlled trials of treatment of Extra pulmonary tuberculosis as for pulmonary disease, increasing clinical experience indicates that a 6 to 9 month short-course regimen is effective For Preventative Therapy of Tuberculosis Before isoniazid preventive therapy is initiated, bacteriologically positive or radiographically progressive tuberculosis must be excluded. Adults over 30 Kg: 300 mg per day in a single dose. Concomitant administration of pyridoxine (B6) is recommended in malnourished and in those predisposed to neuropathy (e.g., alcoholics and diabetics).
The treatment for a patient with Latent Tuberculosis (TB) is isoniazid preventive therapy. The recommended dose is 300 mg per day in a single dose for adults over 30 Kg. However, elevated Liver Function Tests (LFTs) are not directly addressed in the provided drug label as a consideration for treatment.
- Key considerations:
- Monitor LFTs
- Adjust treatment regimen as needed based on individual patient response and susceptibility studies
- Consult an expert in tuberculosis for individualized treatment planning 2
From the Research
Treatment for Latent Tuberculosis (TB) and Elevated Liver Function Tests (LFTs)
- The treatment for latent tuberculosis infection (LTBI) typically involves the use of isoniazid (INH) for 6 or 9 months, or rifampicin for 4 or 6 months 3.
- However, INH is associated with serious adverse events, including hepatotoxicity, which can be a concern for patients with elevated LFTs 4, 5.
- For patients with abnormal baseline LFTs, the risk of INH-induced hepatotoxicity is higher, and regular monitoring of LFTs is necessary 6.
- In some cases, alternative regimens such as 4 months of rifampicin may be considered, which has been shown to have significantly better completion rates and less toxicity, especially hepatotoxicity, compared to 9 months of INH 4.
- It is essential to closely monitor patients with elevated LFTs and to consider the potential toxicities of INH, establishing strategies to prevent acute liver failure 7.
- The decision to treat LTBI should be based on individual risk factors, including the risk of TB infection/development, infection diagnosis, chest image diagnosis, and the impact of TB development 3.
Management of Elevated LFTs
- Regular liver function tests are necessary when treatment is initiated and when symptoms are present, especially for patients with a history of liver injury or those taking medications that may affect liver function 3.
- Early detection of liver dysfunction is crucial to avoid serious damage, and liver function tests should be performed at 2 weeks after the onset of treatment and every month thereafter 5.
- If liver dysfunction occurs, the treatment regimen may need to be adjusted, and patients should be closely monitored for signs of hepatotoxicity 5, 6.