Alcohol use affects TB treatment toxicity by increasing risk of hepatotoxicity, especially with which drugs?

• A. Ethambutol
• B. Streptomycin
• C. Rifabutin
• D. Isoniazid, rifampin, and pyrazinamide

Answer: (D)

Alcohol use increases the risk of liver injury during TB therapy because several frontline TB drugs are processed by and can damage the liver. The drugs with the strongest association to hepatotoxicity are isoniazid, rifampin, and pyrazinamide. When alcohol is involved, the liver faces added stress from both the drugs and alcohol metabolism, making drug-induced hepatitis more likely. Ethambutol and streptomycin are not primarily hepatotoxic—ethambutol more often affects the eyes, and streptomycin tends to cause kidney and ear toxicity. Rifabutin can also affect the liver but is not the classic high-risk pair with alcohol in standard regimens.