How should suspected hepatotoxicity during TB therapy be managed?

• A. Increase the dose of all TB drugs.
• B. Temporarily discontinue suspected offending drug(s), assess liver function, and reintroduce drugs one by one after improvement.
• C. Continue therapy and monitor without changing.
• D. Switch immediately to non-TB antibiotics.

Answer: (B)

Managing suspected hepatotoxicity during TB treatment means stopping the drugs most likely causing liver injury, then checking liver function and clinical symptoms as the liver healing occurs. This pause protects the liver from further damage while you determine which medication is responsible. Once liver enzymes have normalized and symptoms have resolved, you reintroduce the anti-TB drugs one at a time, monitoring closely for any return of elevated enzymes or symptoms. If a particular drug triggers hepatotoxicity again, that drug is stopped permanently and a substitute is used so you can keep the TB regimen effective. The other drugs can be reintroduced or adjusted as needed. This approach balances patient safety with continuing treatment to prevent resistance. Increasing doses, continuing unchanged, or switching to non-TB antibiotics would not address the risk and could worsen outcomes.