Objective: To investigate the incidence of liver injury induced by anti-tuberculosis drugs in children and related influencing factors

so as to provide reference for medical staff engaged in the diagnosis and treatment of children infectious diseases to develop antituberculosis regimens. Methods: Retrospective analysis was performed on 227 cases of children from 0 to 14 years diagnosed with pulmonary or extrapulmonary tuberculosis and received anti-tuberculosis drug therapy in the Fourth People’s Hospital of Nanning from 2017 to 2021. Occurrences of drug-induced liver injury and related factors were subjected for statistical analysis. Results: Among the 227 children with tuberculosis undergoing anti-tuberculosis therapy

56 cases ( 24. 7%) experienced drug-induced liver injury. Specifically

13 cases were infants (⩽1 year) and liver injury occurred in 8 cases (61. 5%). The occurrence of drug-induced liver injury was commonly within 1 week after drug administration (25 cases

44. 6%); 53 cases (94. 6%) of adverse drug reactions occurred within 2 months after drug administration. Intravenous drug administration

combined use of multiple anti-tuberculosis drugs

and tuberculosis children with concurrent HIV infection had a higher probability of drug-induced liver injury. The risk factors for children with tuberculosis-related drug-induced liver injury were found to be associated with age

administration route

drug combination

duration of treatment

and concurrent HIV infection

while gender showed no significant correlation. The main clinical manifestations of liver injury induced by tuberculosis in children were asymptomatic elevation of liver enzymes (64. 3%) and obvious clinical symptoms (35. 7%) such as poor appetite

nausea

vomiting

abdominal pain

and rash. Conclusion: Infants (⩽1 year) with tuberculosis have a higher probability of drug-induced liver injury during anti-tuberculosis therapy. Liver injury tends to occur within the first week of administration

the majority of cases manifesting as asymptomatic elevation of liver enzymes within 2 months after administration. It is recommended to monitor liver function in the first and second weeks after initiating treatment

every 2 weeks until 2 months

and then monthly until completion of the course.