Which TB drugs carry a notable risk of hepatotoxicity, particularly with alcohol use?

• A. Isoniazid and Pyrazinamide carry significant hepatotoxic risk; Rifampin also hepatotoxic
• B. Ethambutol and Streptomycin
• C. Rifampin only
• D. Isoniazid only

Answer: (A)

The key idea is that certain TB drugs carry a real risk of liver injury, and alcohol use compounds that risk. Isoniazid is well known for hepatotoxicity, with risk that rises in people who drink alcohol, are older, or have existing liver disease. Pyrazinamide also commonly causes hepatitis, and its risk is amplified when alcohol is involved. Rifampin can cause liver injury as well, though usually to a lesser degree than isoniazid and pyrazinamide; when used together, the total risk to the liver increases and monitoring is important. Ethambutol and streptomycin are not primarily linked to hepatotoxicity—ethambutol tends toward optic neuritis and streptomycin toward ear and kidney toxicity. So, the best choice highlights that isoniazid and pyrazinamide carry notable hepatotoxic risk, with rifampin also having hepatotoxic potential.