HOME
Return to Table of Contents
189 USE OF ETHAMBUTOL AND A QUINOLONE IN PPD-POSITIVE PATIENTS WITH ADVANCED CIRRHOSIS BEFORE OR AFTER LIVER TRANSPLANTATION M LaRocque, R Lalonde, P Ghali, N Hilzenrat, J Barkun, P Metrakos, J Tchervenkof, M Deschênes BACKGROUND: The first and second line treatments for latent tuberculosis (TB) are isoniazid for nine months or rifampin for four months, respectively. Both are hepatotoxic. Patients under consideration for liver transplantation who have a positive PPD need treatment for latent TB because the future use of antirejection drugs constitutes a very high risk for TB reactivation. We have evaluated the combination of ethambutol (EMB) 15 mg/kg and a quinolone in PPD positive patients with advanced liver disease or early after liver transplantation when unable to tolerate the first or second line anti TB treatment.
McGill University Health Centre, Montreal, Quebec
OBJECTIVE: To describe the outcome of 17 patients with advanced liver disease or who are early after liver transplantation treated with EMB and either 500 mg of ofloxacin (OFLOX) or 400 mg of levofloxacin (LEVO) for a positive PPD.
METHODS: After obtaining appropriate ethics approval, a retrospective analysis of data from the Royal-Victoria Hospital transplant clinic (Montreal, Quebec) database was performed. Hospital records were used to validate some data.
RESULTS: We reviewed 17 patients with a positive PPD who were treated with EMB and either OFLOX (15 pts) or LEVO (2 pts). There were seven women and 10 men, mean age 58-years-old. Six patients underwent treatment shortly before and 11 underwent treatment after liver transplantation. Patients received anti-TB treatment for nine to 12 months, except for one who died of acute graft failure shortly after transplantation, and thus received therapy for only seven months. Median follow-up was 32 months. No reactivation of TB was observed. Routine ophthalmological examination did not detect any cases of optic neuritis. There was no decline in Child-Pugh score of any patient, except the one who died of acute graft failure. Five patients died in the post transplant period, none from TB or adverse effects attributed to EMB, OFLOX or LEVO. Two died of recurrent hepatitis C, one of an angiosarcoma, one of sepsis and one of graft failure.
DISCUSSION: The combination of EMB and a quinolone has been used to treat latent TB with presumed drug-resistant bacteria. This is, to our knowledge, the first report of its use in the context of advanced liver disease and liver transplantation, when first and second line regimens were contraindicated. The regimen was well tolerated and appears to have successfully prevented reactivation of TB. We propose that the combination of EMB plus an anti-TB quinolone seems to be an effective and safe alternative therapy in those patients.