Pustaka Ilmiah Universitas Padjadjaran

Abstrak

Hospitalized Pediatric Antituberculosis Drug Induced Hepatotoxicity: Experience Of An Indonesian Referral Hospital

Objective: To determine the characteristics and risk factors of pediatric antituberculosis drug induced hepatotoxicity (ADIH) in Dr. Hasan Sadikin Hospital, a referral hospital in West Java, Indonesia. Methods: Medical records of hospitalized pediatric ADIH from October 2010 to October 2015 were reviewed retrospectively through computer-based search. Descriptive data were presented as percentage. Analytical case-control study on characteristics of ADIH was conducted using Chi-square and Mann Whitney test. Results: Fifty (3.5%) out of 1 424 pediatric TB patients developed ADIH; 20 (40%) were boys and 30 (60%) girls. More than half were under 5 years old and 33 (66%) were malnourished. ADIH occured in 29 (58%) cases treated for pulmonary TB, 15 (30%) for extrapulmonary TB and 6 (12%) for both; 34 cases (68%) occured during the intensive phase. We identified hepatic comorbidities including CMV infection [1 (2%)] and typhoid [1 (2%)], and other diseases treated by hepatotoxic drugs such as chemotherapeutic drugs, antiepileptics, and antiretroviral drugs [9 (18%)]. Case-control analysis of 50 ADIH cases and 100 TB controls without ADIH showed that the correlation between gender, age, type of TB, nutritional status and comorbidities to occurence of ADIH was statistically insignificant (P= 0.26, 0.765, 0.495, 0.534 9 and 0.336, respectively). Pediatric ADIH was treated using modified British Thoracic Society guidelines. Conclusions: Pediatric ADIH in our hospital is quite frequent, thus identifying risk factors and development of pediatric guideline is mandatory. Further study is needed to identify other risk factors such as genetic acetylator status.