Initial treatment of tuberculosis with rifampicin

The effect of rifampicin on liver morphology in tuberculous alcoholics

Seventy-nine consecutive patients receiving rifampicin in combination with isoniazid and another drug, were found to have an 8-3% incidence of acute clinical liver disease. Half the patients (36) were advanced alcoholics and almost all cases of hepatitis came from this group. Fifteen of the 36 were thought to have evidence of pre-existing liver disease and were studied by means of serial liver biopsies. Most of those with pre-treatment abnormalities of liver function developed abnormalities in their biopsies, not attributable to alcohol. In one patient active chronic hepatitis is believed to have followed irregularly taken rifampicin. Those patients with both normal pretreatment liver function and biopsies did not develop histological abnormalities. The dangers of irregularly taken self-administered rifampicin are stressed. It is suggested that rifampicin is contraindicated in alcoholics with initial abnormal liver function tests.