Unnoticed side effect of isoniazid during childhood tuberculosis
preventive treatment: Hyperuricemia
Abstract
Isoniazid for 6-9 months is the most widely used form of tuberculosis
(TB) preventive treatment. We aimed to assess the side effects of
isoniazid by using the serum levels of aspartate transaminase (AST),
alanine transaminase (ALT), and uric acid (SUA) in children and
adolescents receiving long term isoniazid for latent tuberculosis
infection. The study included children ≤18 yrs of age who underwent TB
preventive treatment with isoniazid (IPT) between 2015 and 2019 at an
university hospital. Serum transaminase, SUA, urea, and creatinine
levels of patients were measured before the initiation of IPT, 15th day,
and once a month during treatment. Patients with either ALT, AST, or SUA
results above cut-off levels during treatment were evaluated. The final
values in follow up were included in the analysis of the data. A total
of 141 children who underwent IPT were included. Seventy children had
family members with confirmed tuberculosis disease and 71 children had
TST positivity. SUA increased above cut-off values in 16 children
(11.3%) and half of them had uric acid levels over 7 mg/dL. The median
duration of the development of hyperuricemia was 4.0 months. ALT or AST
increased above cut-off values in 23 children (16.3%). ALT was above
cut-off values in 7 patients, AST was high in 20 patients. The median
duration to the development of AST and/or ALT levels above cut-off was
4.0 months. Two patients had hepatotoxic transaminase levels. Three
patients had both elevated transaminases and SUA levels. İsoniazid may
also cause hyperuricemia beside elevation in transaminases in children.