The World Health Organization’s “End TB strategy” envisions a world free of tuberculosis (TB), emphasizing early diagnosis, effective treatment, and prevention. The Government of Nepal has incorporated innovative activities into its National Strategic Plan and the “TB Free Initiative.” Despite these initiatives, significant challenges remain, particularly concerning hepatotoxicity during antitubercular therapy, its management, and the treatment of tuberculosis in patients with chronic liver disease (CLD). Drug-induced liver injury (DILI) is a leading cause of treatment interruption, nonadherence, and therapeutic failure. Among these, antitubercular drug-induced liver injury (ATT-DILI) represents a distinct and clinically significant concern that requires focused attention. In patients with chronic liver disease, appropriate selection of antitubercular regimens based on the severity of liver disease is essential for successful TB treatment. A tailored approach that balances efficacy and safety is necessary. This article proposes a strategy based on monitoring and modification to assist clinicians in managing hepatotoxicity associated with antitubercular agents in patients with chronic liver disease.
Tiwari et al. (Sat,) studied this question.