Pharmacy Division Ramathibodi Hospital


News 01/05/2544

The combination of the antituberculosis drugs rifampin and pyrazinamide killed a 53-year-old man after 5 weeks on the therapy.

Rifampin and Pyrazinamide Combination Can Be Lethal

ATLANTA (Reuters Health) Apr 19 - The combination of the antituberculosis drugs rifampin and pyrazinamide killed a 53-year-old New York man, who died in September 2000 from hepatitis after 5 weeks on the therapy, according to a report from the US Centers for Disease Control and Prevention (CDC), in Atlanta.

The combination was given as an alternative to isoniazid, in line with the recommendations of the American Thoracic Society. In December 2000, another severe case of hepatitis associated with the drug combination was reported in Georgia, when a 59-year-old woman was admitted to the hospital after 7 weeks of therapy, CDC researchers write in the April 20th issue of Morbidity and Mortality Weekly Report.

"Both rifampin and pyrazinamide have been independently linked to liver injury," Dr. John A. Jereb, from the CDC's National Center for HIV, STD, and TB Prevention, told Reuters Health. "We don't have any evidence that they might be worse when used in combination, but we do know that pyrazinamide has a higher chance of causing liver injury than rifampin does."

According to Dr. Jereb, it is virtually impossible to predict who might suffer liver injury from these drugs. "It would be one of our greatest wishes" to be able to distinguish that," he said.

He asked that TB controllers notify the CDC if they encounter cases of liver injury like those reported, because the CDC would like to monitor the situation. "It's possible that if we could collect more information about other patients, we might sort out who might be at risk for liver injury," Dr. Jereb said.

The CDC recommends that healthcare providers remind TB patients during each visit or at least monthly to stop taking their medication and contact their provider if symptoms, such as gastrointestinal pains, develop.

MMWR Morb Mortal Wkly Rep 2001;50:289-291.

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