Comparison of British Thoracic Society and American Thoracic Society reintroduction guidelines for anti-tuberculous therapy induced liver injury

Objective: to compare the efficacy of british thoracic society and american thoracic society guidelines for reintroduction of anti-tuberculous therapy after drug-induced liver injury, and to assess the ease of administration of each guideline on a scale of 1-10. methods: the randomised prospective interventional study was conducted at the department of medicine and pulmonology, dow university of health sciences, karachi, from december 2011 to november 2013. patients with anti-tuberculous therapy drug-induced liver injury were selected. hepatotoxic anti-tuberculous therapy was stopped and modified anti-tuberculous therapy was started. patients were followed weekly till clinical and biochemical parameters got stabilised. after stabilisation, the patients were randomised to one of the two groups to receive re-introduction of anti-tuberculous therapy under the guidelines of british thoracic society (group i) or those of american thoracic society (group ii). means of the groups were analysed by student's t test and proportions were compared by chi-square test. multivariate analysis was done for age, body mass index and serum albumin for recurrence of drug-induced liver injury after the re-introduction. p value <0.05 was taken as significant. results: of the total 325 patients, 163(50.15%) were in group i, while 162(49.84%) were in group ii. the frequency of recurrence of drug-induced liver injury in group i was 16 (9.8%) and in group ii it was 18 (11.1%). there was no statistically significant difference between the two groups (p<0.7). age was positively related with drug-induced liver injury, while body mass index and serum albumin were negatively associated. conclusion: there was no significant difference between the two major guidelines though the american thoracic society guideline was easier to follow.