Ceftriaxone-induced hepatotoxicity in patients with common medical infections in Qatar: A retrospective study

Abstract

Introduction: Ceftriaxone, a third-generation cephalosporin, is frequently used for the treatment of various bacterial infections as a broad-spectrum antibiotic for many decades. Although ceftriaxone is a well-tolerated drug in most cases, it can lead to serious liver injury, which can be a real challenge to the treating physician. Given the potentially serious adverse effects that can vary from mild biochemical abnormalities to complete liver failure, we intend to assess the spectrum of liver injury based on biochemical criteria for patients treated with ceftriaxone for common bacterial infections in Qatar.Objectives: This study aimed to explore the incidence of ceftriaxone-induced liver injury at Hazm Mebaireek General Hospital, Qatar, and to evaluate the relationship of the ceftriaxone dose, if any, with liver dysfunction.Methods: This retrospective study included hospitalized adult patients treated with ceftriaxone at our hospital from January 2019 to December 2019 and analyzed demographic and clinical data obtained from electronic medical records. This study determined the incidence of liver injury (primary outcome) in patients treated with ceftriaxone (2 g/day) for ≥ 2 consecutive days by reviewing liver function test results until the day of discharge and at the first outpatient follow-up. Results: The final data analysis included a total of 634 patients admitted and treated with ceftriaxone from January 2019 to December 2019.In the multivariate analysis with propensity score adjustment, ceftriaxone was independently associated with liver injury, especially when combined with other agents utilizing hepatic metabolism.Conclusions: Ceftriaxone was associated with a significantly higher incidence of liver injury (19.7%) when used along with other medications that are metabolized in the liver, as found in the present study compared with other similar studies (approximately 2.9%–13.9%). Furthermore, the incidence was too high to be ignored in clinical practice.

Ceftriaxone-induced cholestatic hepatitis in a child: A case report and a review of the literature

“…In a recent retrospective study by Barman et al in the adult population treated with ceftriaxone from January 2019 to December 2019, among the 634 patients included in the study, ceftriaxone was associated with liver injury in 19.7% of cases, especially when used along with other medications that are metabolized in the liver (9). In the pediatric population, the large, multi-database, population-based, case-control study of Ferrajolo et al demonstrated that the use of antibiotics is associated with a threefold increased risk of liver injury compared with past use.…”

“…In a recent retrospective study by Barman et al in the adult population treated with ceftriaxone from January 2019 to December 2019, among the 634 patients included in the study, ceftriaxone was associated with liver injury in 19.7% of cases, especially when used along with other medications that are metabolized in the liver ( 9 ).…”

In silico prediction of drug‐induced liver injury with a complementary integration strategy based on hybrid representation

“…The cholestasis mechanism is related to hepatotoxicity of cephalosporin. Overdose of cephalosporin-based antibiotics will also result in elevated transaminase and bilirubin levels [52][53]. In contrast, quinolones, also known as pyridoxic acids, are often reported with adverse reactions related to hepatotoxicity, similar to cephalosporin antibiotics [54].…”

Pengaruh Faktor Risiko terhadap Kejadian Peningkatan Kadar Enzim Transaminase pada Pasien Covid-19 dengan Terapi Tocilizumab

“…Hal ini sejalan dengan penelitian retrospektif yang dilakukan di Qatar dengan melibatkan 634 pasien yang menerima terapi ceftriaxone. Hasilnya menunjukkan bahwa terapi ceftriaxone bersamaan dengan obat lain dikaitkan dengan peningkatan insiden DILI yang signifikan (P < 0.01) (14).…”