- 28 May 2011
Patients who are being treated for latent tuberculosis should be monitored periodically for the following:• Signs and symptoms of active tuberculosis• Adherence to the prescribed regimens• Complications from the medical regimens, especially hepatitisPatients should be educated on the signs and symptoms of hepatitis and should be instructed to stop medications and seek medical attention immediately for such an event. Patients on isoniazid should be monitored at least monthly. Routine monitoring of liver enzymes for patients on isoniazid is indicated when baseline liver readings are elevated or when risk factors for liver disease are present. Patients on pyrazinamide and rifampin should be seen every 2 weeks, and testing of liver enzymes and bilirubin should be obtained. If signs or symptoms of hepatoxicity develop, the liver enzymes should be tested and the medical regimen should be discontinued. Approximately 10% to 20% of patients taking isoniazid will develop some mild asymptomatic elevation of liver-associated enzymes. These are usually self-limited and do not necessitate discontinuation of therapy. If elevations in liver-associated enzymes exceed five times the upper limit of normal or the patient notes abdominal symptoms, then the drug should be discontinued, and the patient followed closely for signs of hepatotoxicity.*58/348/5*
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