OBJECTIVE : To compare the outcome of treatment with silymarin or N-acetyl cysteine in patients taking anti-tuberculous drugs for tuberculosis at Tertiary Care Hospital, Karachi.
SAMPLE SELECTION : Patients presenting with tuberculosis previously not on anti-tuberculous drugs, between 40-80 years of age, both genders will be included .Patients with history of alcohol use,Discontinuation of drug due to other adverse effects except hepatotoxicity ,Inadequate date of laboratory testing at baseline or 2 to 4 weeks after treatment initiation, Cases with human immunodeficiency virus (HIV) co-infection, viral hepatitis, or suspected mal absorption (e.g., gastrointestinal disease or diarrhea) ,Chronic liver disease, COPD, asthma, myocardial infarction, chronic kidney disease and stroke will be excluded
Patients presenting with tuberculosis and previously not on any anti-tuberculous drugs, between 40-80 years of age
either gender.
History of malignancy.
Patients with history of seropositive, seronegative, connective tissue disorder or vasculitis, congestive cardiac failure.
Patients with history of alcohol use.
Discontinuation of drug due to other adverse effects except hepatotoxicity.
Parallel
Silymarin 420 mg
Drugsilymarin group received silymarin 140mg thrice daily along with antituberculous drugs for 14 days
N Acetyl Cysteine
DrugN- acetylcysteine group will receive N-acetylcysteine 900mg once daily with antituberculous drugs for 14 days
Rifampicin (RMP) Ethambutol (E) Isoniazid (H) Pyrazinamid (Z)
DrugAntituberculous drugs only
Anti-Tuberculous Drug induced Hepatotoxicity
Outcome will be assessed in patients developing Anti-tuberculous Drug-Induced Hepatotoxicity. Patients diagnosed with TB and started on a regimen based on isoniazid, rifampicin, pyrazinamide, and ethambutol will be labeled as having Anti-tuberculous Drug-Induced Hepatotoxicity using liver function tests. It will be labeled if any one of the following criteria is met: * Rise in alanine aminotransferase (ALT) more than or equal to a fivefold increase from the upper limit of normal (\>37 IU/L) * Rise in alkaline phosphatase (ALP) more than or equal to twofold increase from the upper limit of normal (\>147 IU/L). * An increase in alanine aminotransferase (ALT) to three or more times the upper normal limit (greater than 37 IU/L), accompanied by a simultaneous rise in bilirubin levels to more than twice the upper normal limit (exceeding 1.5 mg/dL), will be considered significant.
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