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December 15, 1999

Toxicity Associated With Isoniazid Preventive Therapy

Author Affiliations

Phil B.FontanarosaMD, Interim CoeditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephenLurieMD PhD, Fishbein FellowIndividualAuthor

JAMA. 1999;282(23):2207-2208. doi:10.1001/jama.282.23.2207

To the Editor: The study from the Seattle Health Department by Dr Nolan and colleagues1 that found no isoniazid-associated deaths in 11,141 patients receiving isoniazid preventive treatment creates hope that isoniazid can be used more aggressively to prevent tuberculosis. However, during the same period the Centers for Disease Control and Prevention (CDC) confirmed that 8 patients in New York taking isoniazid preventive treatment died of liver failure or required a liver transplant.2 A survey of pediatric liver transplant services found that 10 children or adolescents receiving isoniazid preventive treatment had the same previously unreported adverse events during a 10-year period ending in 1997 (Catherine Chao, MD, oral communication, April 1999). Furthermore, either the CDC or I have been made aware of 7 additional cases, which results in a total of 25 putative cases. (John Jereb, MD, oral communication, April 1999). These contradictory reports raise the question "Why is isoniazid safe in Seattle but less safe elsewhere?"

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