https://www.ncbi.nlm.nih.gov/pubmed/30234790

Pediatr Infect Dis J. 2018 Sep 18. doi: 10.1097/INF.0000000000002192. [Epub ahead of print]
Antituberculosis Drug-Induced Liver Injury in Children: Incidence and Risk Factors During the Two-Month Intensive Phase of Therapy.
Gafar F, Arifin H, Jurnalis YD, Yani FF, Fitria N, Alffenaar JC, Wilffert DB.

Abstract

BACKGROUND:
As one of the most frequent and serious adverse reactions during tuberculosis treatment, antituberculosis drug-induced liver injury (ATLI) in children has been studied insufficiently compared with adults. We aimed to determine the incidence and risk factors of ATLI in children during the first two months of TB-therapy.

METHODS:
A total of 41 children with tuberculosis and treated with first-line antituberculosis drugs were prospectively followed-up for the development of ATLI.Liver function tests were performed at baseline and after two weeks of therapy. Subsequent tests were conducted at 4, 6 and eight weeks if the initial 2-week measurement was abnormal, or if symptoms of hepatotoxicity were reported.

RESULTS:
ATLI was detected in 11 (27%) patients within 14 to 42 days from the start of therapy, with most of them (54%) occurred after two weeks. TB treatment was stopped immediately in 6 out of 11 patients who developed ATLI, and no recurrent hepatotoxicity after drug reintroductions in these patients. Univariate analysis showed that ATLI was significantly associated with TB meningitis (p<0.01), hypoalbuminemia (p<0.05) and hepatotoxic co-medications (p<0.01). Age, gender, nutritional status, HIV status, and baseline liverfunction abnormalities were not associated with ATLI. Multivariate analysis identified hypoalbuminemia and hepatotoxic co-medications (both p<0.1) tend to be independently associated with ATLI.

CONCLUSIONS:
Children with hypoalbuminemia and use of hepatotoxic co-medications are suggested to be monitored closely for the development of ATLI.