ISONIAZID-RELATED FATAL HEPATITIS

To describe the clinical and demographic characteristics of fatal hepa titis due to single-drug isoniazid preventive therapy for tuberculosis , we did a survey of cases from state health departments, published ca se reports, and reports to the Centers for Disease Control and Prevent ion from 1970 to 1992. Of 108 reported cases, some clinical informatio n was available for 76. A medical review panel judged 39 of these deat hs as probably due to isoniazid hepatitis and 23 deaths as possibly du e to isoniazid hepatitis. Of the 62 probable and possible cases combin ed, 50 (81%) were female, 49 (79%) were non-Hispanic black or Hispanic , and 19 (31%) were younger than 35 years. The median duration of ison iazid preventive therapy before symptom onset was 16 weeks. Of the 60 cases with symptom information, 54 (90%) presented with jaundice. Of t he 62 cases, 26 (42%) were monitored monthly in accordance with curren t recommendations, and 5 of the patients were younger than 35 years. W e estimate that the rate of fatal isoniazid hepatitis among patients i n the public sector was no greater than 4.2 per 100,000 persons beginn ing therapy and no greater than 7 per 100,000 persons completing thera py. Adherence to isoniazid preventive therapy guidelines apparently re duces, but does not eliminate, the risk of fatal hepatitis. Careful pa tient selection, education, and monitoring are critical for minimizing that risk.