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Open Access Research article

Drugs and herbs given to prevent hepatotoxicity of tuberculosis therapy: systematic review of ingredients and evaluation studies

Qin Liu1*, Paul Garner2, Yang Wang1, Binghua Huang1 and Helen Smith2

Author Affiliations

1 School of Public Health, Chongqing Medical University, No.1 Yixueyuan Road, Chongqing, PR China

2 International Health Group, Liverpool School of Tropical Medicine, Liverpool, UK

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BMC Public Health 2008, 8:365  doi:10.1186/1471-2458-8-365

Published: 21 October 2008

Abstract

Background

Drugs to protect the liver are frequently prescribed in some countries as part of treatment for tuberculosis. The biological rationale is not clear, they are expensive and may do harm. We conducted a systematic review to a) describe the ingredients of "liver protection drugs"; and b) compare the evidence base for the policy against international standards.

Methods

We searched international medical databases (MEDLINE, EMBASE, LILACS, CINAHL, Cochrane Central Register of Controlled Trials, and the specialised register of the Cochrane Infectious Diseases Group) and Chinese language databases (CNKI, VIP and WanFang) to April 2007. Our inclusion criteria were research papers that reported evaluating any liver protection drug or drugs for preventing liver damage in people taking anti-tuberculosis treatment. Two authors independently categorised and extracted data, and appraised the stated methods of evaluating their effectiveness.

Results

Eighty five research articles met our inclusion criteria, carried out in China (77), India (2), Russia (4), Ukraine (2). These articles evaluated 30 distinct types of liver protection compounds categorised as herbal preparations, manufactured herbal products, combinations of vitamins and other non-herbal substances and manufactured pharmaceutical preparations. Critical appraisal of these articles showed that all were small, poorly conducted studies, measuring intermediate outcomes. Four trials that were described as randomised controlled trials were small, had short follow up, and did not meet international standards.

Conclusion

There is no reliable evidence to support prescription of drugs or herbs to prevent liver damage in people on tuberculosis treatment.