The Changes in Levels of Serum Alanine Aminotransferase (ALT) During Anti Tubercular Treatment With 4FDC (Fixed Drug Combination)

Tuberculosis (TB) is emerging as a major public health problem in Bangladesh, which now has the fifth highest burden of TB cases globally. Treatment of TB hampered with poor patient compliance and intolerance at least partly due to the adverse drug reactions, one of which is hepatotoxicity. Serum alanine aminotransferase level is an important indicator of such condition and impacts upon the continuation of anti tubercular treatment. A prospective randomized case study was conducted among 62 patients diagnosed as pulmonary tuberculosis receiving category I anti-TB drug treatment regimen in the DOTS (Direct observation therapy shortcourse) providing centers at Pabna district under DOTS during the period of July 2004 to July 2006. Category I comprised of four drugs (Rifampicin, Isoniazid, Ethambutol, Pyrazinamide) combination patients treated for initial 2 months, serum alanine aminotransferase levels were estimated at the first and fourth week of the treatment. Serum billirubin, HBsAg, Anti-HCV was also done to exclude some other liver diseases. 14(22.58%) patients were found to have no significant change, 34(54.84%) patients had their levels in the upper limits, 13(20.97%) patients had their levels in-between the upper limit and twice of the upper limit, while only 1(1.6%) patient crossed the level twice the upper limit. TAJ 2009; 22(1): 106-110 1 Associate Professor, Department of Medicine, Rajshahi Medical College, Rajshahi. 2 Assistant Professor, Department of Medicine, Rajshahi Medical College, Rajshahi. 3 Associate Professor, Department of Dermatology, Rajshahi Medical College, Rajshahi 4 Indoor Medical Officer, Department of Medicine, Rajshahi Medical College, Rajshah