rifampin and Liver-Diseases--Alcoholic

The etiology and the pathogenesis of different forms of hepatotoxicity are discussed; case reports are included to illustrate the importance of history-taking and examination of liver tissue in establishing a specific diagnosis. The role of alcohol as a hepatotoxin as well as an enzyme-inducing agent is stressed. Genetic factors have been identified that may determine susceptibility to alcoholism and the hepatotoxic effects of alcohol and other compounds. Some cases of drug-induced cholestasis may be explained by disturbances in the known pathways of bile acid uptake, transport, and excretion. The importance of small duct destruction in patients with progressive drug-induced cholestasis is discussed. Finally, the potential hepatic complications of some nonprescription remedies used by adherents of "alternative medicine" are described, emphasizing the relevance of thorough etiological inquiry in all patients presenting with hepatic dysfunction.

Topics: Acetaminophen; Acetylcysteine; Adenoma, Liver Cell; Adult; Amoxicillin; Anabolic Agents; Beverages; Chemical and Drug Induced Liver Injury; Cholestasis, Intrahepatic; Contraceptives, Oral; Female; Humans; Isoniazid; Liver Diseases; Liver Diseases, Alcoholic; Liver Neoplasms; Male; Nonprescription Drugs; Propylthiouracil; Rifampin

Every year since 1972 all records pertaining to an unselected group of tuberculous patients were collected on August 1st and analysed with the view of establishing trends and detecting special problems associated with anti-tuberculous chemotherapy. One of the subjects of the analysis was to find the effects of chemotherapy on the global transaminase levels. The case material was divided into two groups: in group 1 rifampicin had been included in the therapy, in group 2 it had been omitted. In approximately 20% of the patients treated during 1976, 1977 and 1978 transaminase levels were already increased when they were admitted to hospital; in about 15% transaminase levels rose during treatment. The personal history of the patients showed that in 31% of the cases the disturbed liver function was attributable to alcohol abuse and that in 22% manifest damage to the liver had been diagnosed prior to admission. Despite these "unfavourable pre-conditions" antituberculous drug therapy succeeded in 50% of the patients in normalizing the transaminase levels, even if the original values had been fairly high. Further controlled studies have confirmed these observations but an interpretation of the results is not yet possible. Antituberculous drug therapy induced a rise in transaminase levels less frequently than it caused a return to normal of initially raised levels. As so many factors are involved it is impossible to single out any particular causal factor.

Topics: Antitubercular Agents; Female; Humans; Liver Diseases, Alcoholic; Male; Rifampin; Transaminases; Tuberculosis