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Twenty isoniazid-associated deaths in one state
T S Moulding1, A G Redeker, G C Kanel
1Department of Pulmonary Medicine, Harbor-UCLA Medical Center, University of California, Los Angeles 90509.
The American Review of Respiratory Disease
|September 1, 1989
Summary
Isoniazid (INH) use led to 20 hepatitis deaths in California over 14 years. Management errors, like not stopping INH for symptoms, were common, highlighting the need to reconsider its preventive treatment guidelines.
Area of Science:
- Hepatology
- Pharmacovigilance
- Public Health
Background:
- Isoniazid (INH) is a key drug for tuberculosis treatment and prevention.
- Isoniazid-associated hepatitis (IAH) is a serious adverse event.
- Previous data on IAH mortality in California was limited.
Purpose of the Study:
- To document deaths associated with isoniazid-induced hepatitis in California.
- To identify risk factors and management issues in fatal isoniazid-associated hepatitis cases.
- To inform recommendations for isoniazid preventive therapy.
Main Methods:
- Retrospective review of reported isoniazid-associated hepatitis deaths in California over 14 years.
- Analysis of patient demographics, treatment history, clinical presentation, and management.
- Comparison of patient characteristics and outcomes.
Main Results:
- Twenty deaths from isoniazid-associated hepatitis were identified over 14 years.
- Management errors, including delayed discontinuation of isoniazid upon symptom onset, occurred in at least 35% of cases.
- Fatal cases disproportionately affected women aged 15-55, with some cases linked to pregnancy and postpartum use.
Conclusions:
- Isoniazid-associated hepatitis remains a significant cause of mortality.
- Improved patient monitoring and adherence to treatment guidelines are crucial.
- Reconsideration of indications and precautions for isoniazid preventive treatment is warranted.
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