ATS recommends first-line anti tuberculosa , especially rifampin , should not be

dismissed at the time suffering from mild indigestion , which occur at relatively early
weeks of treatment anti tuberculosa . Patients who experience severe tuberculosa , could
die if not given OAT . To prevent this , patients can be treated with regimens that are not
hepatotoxic . After liver function returned to normal , with OAT TB treatment must be
started again .
Alternative regimen depends on what drugs that cause hepatitis .
O If caused by rifampicin regimen without rifampicin is given 2 months of isoniazid ,
ethambutol and streptomycin , followed by 10 months of isoniazid and ethambutol .
O If isoniazid can not be used , 6- 9 months of rifampicin , pyrazinamide and ethambutol
may be considered
O When pyrazinamide was stopped before patients completed the intensive phase , the
total duration of therapy isoniazid and rifampicin can be continued up to 9 months .
O If isoniazid and rifampicin can not be given , the regimen is not hepatotoxic as
streptomycin , ethambutol and fluoroquinolone should be given up to a total of 18-24
months .
Giving back is a step drug individually optimal , especially if heaptitis suffered
was severe . National TB control program using FDC tablets should store a single antiTB drugs in limited quantities for use in a particular case . However , if the state of health
units do not have a single anti-TB drugs , limited clinical experience has been successful
with the following approach , which depends on whether hepatitis with jaundice occurs
when the initial phase or advanced phase .
O When hepatitis with jaundice occurs during intensive phase pengobatn isoniazid ,
rifampin , and ethambutol pyrazinamid ; that hepatitis has been recovered , give back the
same drugs except streptomycin pyrazinamid replaced with 2 months to complete the
initial phase of treatment , followed by rifampicin and isoniazid for 6 months of
continuation phase.
O When hepatitits with jaundice occurs during the continuation phase , so hepatitsnya
heal , give back isoniazid and rifampicin for 4 months completing the continuation phase
of therapy.

In general , there are different regimens for the reintroduction of OAT in patients
ATDH , but there is no definitive treatment guidelines . A prospective study about giving
back OAT after ATDH conducted in Turkey by Tahaoglu et al and published in 2001. The
study involved 45 patients who received 2 ATDH OAT different administration regimens
in which one group using pyrazinamide while another group did not use pyrazinamide .
Tahaoglu et al found that the risk for recurrence ATDH at the time of re- OAT was 24 %
in the group who received the same regimen as the previous OAT ( using pyrazinamide )
compared with 0 % in the other groups that provide OAT one by one and did not include
pyrazinamide ( P = 0021 ) .
Another study conducted by Surendra K et al , published in 2010 and involving
175 patients ATDH , comparing 3 administration ATDH OAT patients , whereas in group
1 was given isoniazid , rifampicin and simultaneously pirazynamid full dose on the first
day , the second group OAT is given in accordance with the guidelines of the ATS
(American Thoracic Society ) , and the third group was given OAT in accordance with
BTS guidelines (British Thoracic Society ) ( Table 3 ) , the study found the incidence of
occurrence of hepatotoxic back to the three groups did not differ significantly ( P =
0.69 ) .
Three Different regiments for the reintroduction of the Anti -Tuberculosis Drugs .
Study Arm

Regiment

Arm I

H,R, and Z at maximum dosages from day 1

Arm II

R at maximum dosage from day 1, H at maximum dosage from day

8, and Z at maximum dosage from day 15.

Arm III

H at dosage of 100 mg/day from day 1, maximum dosage from day

4 ; R at dosage of 150 mg/day from day 8, maximum dosage from
day11; Z at dosage of 500 mg/day from day 15, maximum dosage
from day 18

Note >> maximum dosage was determined according to body weight, as follows: H, 5
mg/kg; R, 10 mg/kg; and Z, 25 mg/kg. H, Isoniazid; R, Rifampicin; Z, pyrazinamide.

Table 3. Three different regimens for the reintroduction of OAT .

Conclusion

1.Tuberculosis ( TB ) is one of the causes of death due to infectious diseases that can be
cured .
2. The most serious side effects of antituberculosis therapy is anti tuberculosa
hepatotoksikdan frequent cause is rifampicin , isoniazid and pyrazinamide .
3. In patients ATDH , the most important thing is to choose a prescription drug for the
treatment of back - carefully - heart . OAT is given back if the clinical and liver
function had returned to normal
4. If liver function tests are not possible, it is advisable to add 2 weeks after the jaundice
and abdominal pain disappeared before the resumption of TB treatment .
5. If signs and symptoms do not disappear and severe liver disease and OAT may not be
dismissed , then used regimens that are not hepatotoxic .
6.Pemberian back OAT started one by one with the most drug rarely causes
hepatotoxicity is followed by isoniazid and rifampicin .
7. There are a variety of ways giving back ATDH OAT patients , but from a study
conducted by Surendra K et Aldan published in 2010 , there was no significant difference
in recurrence of hepatotoxicity