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INH Hepatotoxicity Monitoring Guidelines

A recent MMWR report describes 17 cases of severe hepatitis due to INH monotherapy identified by a CDC surveillance program between 2004 and 2008.  Hepatic injury led to 5 liver transplants and 5 deaths (one of whom received a liver transplant).  Other remarkable findings were that one patient was HCV/HIV infected, two were children (<15) and the events happened between 2 and 7 months into INH therapy (5 patients at 2 monts, 2 patients at 3 months, 5 patients at 4 months and 3 patients at or after 5 months). 

Its not clear that more frequent monitoring of LFTs would have averted any of these cases since it was symptoms, not LFT abnormalities that, that brought most patients to medical attention.  Nevertheless, it was the opinion of providers that our patients who are started on INH should undergo baseline and monthly monitoring of LFTs while on INH.

March 2010 MMWR:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5908a3.htm

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