Management of Anti-tuberculosis Drug-related Hepatotoxicity: Comparison of the Fluoroquinolone-containing Regimen and Re-challenge with the Standard Regimen

Purpose: The aim of this study was to compare the fluoroquinolone-containing regimen with a re-challenge of the standard regimen in the management of drug-related hepatotoxicity during anti-tuberculosis therapy. Materials and Methods: Of the 60 patients with drug-related hepatotoxicity enrolled in this study, 33 were in the standard regimen group and 27 were in the fluoroquinolone-containing regimen group. Levofloxacin (n=21) and ciprofloxacin (n=6) were the main fluoroquinolones used in this study. The inpatient and outpatient medical records were reviewed for demographic characteristics, dosage and duration of each anti-tuberculosis drug, serial results of liver function tests, treatment outcomes, adverse effects, and medication cost. Results: The duration of treatment was 8.90±3.6 months in the standard regimen group and 9.4±4.7 months in the fluoroquinolone group (ρ=0.642). In all, 29 (87.9%) in the standard regimen group and 21 (77.8%) in the fluoroquinolone group were either cured or completed treatment. No case of treatment failure or relapse was noted after a mean follow-up duration of 17.6±12.9 months in the standard regimen group and 18±9.8 months in the fluoroquinolone group (ρ=0.904). There was a significant difference in the daily cost of medication between the standard regimen group (32±14.7 NTD) and the fluoroquinolone group (153.9±53.5 NTD, p＜0.001). Patients in both groups reported similar adverse effects. Conclusion: The use of fluoroquinolone to replace partial first-line anti-tuberculosis drugs in managing drug-related hepatotoxicity seemed to be not superior to a re-challenge with the standard regimen, in terms of treatment duration, treatment outcomes, and self-reported adverse effects. Cost may be an important concern with fluoroquinolone use. A well-designed randomized controlled prospective study is required to further investigate the observations in the present study.