Changes in markers of liver damage in the treatment of patients with pulmonary tuberculosis with multiple drug resistance of the Mycobacterium tuberculosis

Aim. The study of the frequency and severity of hepatotoxic reactions to antituberculosis drugs in a comparative aspect when initially 4th regimens were used and initially 1 and then 4th chemotherapy regimens in new detected patients with multi-drug-resistant (MDR) tuberculosis. Material and methods. We studied 261 new cases of MDR tuberculosis. Patients were divided into 2 groups. The first group included 164 patients. The resistance of Mycobacterium tuberculosis to rifampicin in these patients determined by using the GeneXpert MTB/RIF method. Treatment of this group of patients was initially conducted according to the 4th regimen of chemotherapy (pyrazinamide, kanamycin/amikacin/capreomycin, fluoroquinolones, cycloserine/terizidone, protionamide, para-aminosalicylic acid). The second group included 97 patients who, before receiving data on MDR Mycobacterium tuberculosis by sputum culture method (2-3 months of treatment), were treated according to the 1st standard chemotherapy regimen (isoniazid, rifampicin, pyrazinamide, ethambutol/streptomycin), followed by correction of treatment with re-registration for 4th regimen. Results and conclusion. It was found that hepatotoxic reactions in patients without initial liver function abnormalities in the appointment of 4 regimens of chemotherapy occurred in 31.3% of cases, when initially treated by 1st regimen, followed by correction for 4th regimen in 87.8% of cases (p<0.001). In the course of treatment, signs of liver damage in patients who initially received 4th regimen of chemotherapy were more likely to occur in the first 2 months of treatment, whereas in patients treated initially with 1st regimen followed by correction for 4th regimens - during the first 4 months. In the overwhelming majority of cases, hepatotoxic reactions were of mild severity, both groups. At the same time, severe hepatotoxic reactions were more frequent in patients of the second group.

GeneXpert MTB/RIF, newly detected tuberculosis, multi-drug-resistance, hepatotoxicity, treatment, GeneXpert MTB/RIF