Drug-induced liver injury due to antibiotics

Abstract

Drug-induced liver injury (DILI) is an important differential diagnosis in patients with abnormal liver tests and normal hepatobiliary imaging. Of all known liver diseases, the diagnosis of DILI is probably one of the most difficult one to be established. In all major studies on DILI, antibiotics are the most common type of drugs that have been reported. The clinical phenotype of different types of antibiotics associated with liver injury is highly variable. Some widely used antibiotics such as amoxicillin-clavulanate have been shown to have a delayed onset on liver injury and recently cefazolin has been found to lead to liver injury 1-3 weeks after exposure of a single infusion. The other extreme is the nature of nitrofurantoin-induced liver injury, which can occur after a few years of treatment and lead to acute liver failure (ALF) or autoimmune-like reaction. Most patients with liver injury associated with use of antibiotics have a favorable prognosis. However, patients with jaundice have approximately 10% risk of death from liver failure and/or require liver transplantation. In rare instances, the hepatoxicity can lead to chronic injury and vanishing bile duct syndrome. Given, sometimes very severe consequences of the adverse liver reactions, it cannot be over emphasized that the indication for the different antibiotics should be evidence-based and symptoms and signs of liver injury from the drugs should lead to prompt cessation of therapy.

Risk stratification for early bacteremia after living donor liver transplantation: a retrospective observational cohort study

“…Additionally, patients with EAD seem to be vulnerable to post-transplant bacteremia, which is related to increased mortality. The optimal treatment regimen for bacteremic patients with EAD, including the type, infusion timing and dosage of drugs, has not yet been established, and anti-bacterial agents may have a negative impact on the liver (i.e., hepatotoxicity) [62]. Therefore, in patients with EAD, early identification of bacteremia and selection of appropriate and sensitive anti-bacterial drugs (ideally with lower hepatotoxicity) represents a good therapeutic strategy for preventing severe sepsis or septic shock.…”

Ameliorative Effect of Curcumin Against Hepatorenal Adverse Effects of Cefepime in Rats

“…Similar result reported cefepime induced liver injury 6 . Other cephalosporins, ceftriaxone 23 , cefixime 24 , cefazolin 25 , cefpirome 26 were reported to induce liver damage with subsequent elevation of liver enzymes.…”

Kang‐Xian Pills Inhibit Inflammatory Response and Decrease Gut Permeability to Treat Carbon Tetrachloride‐Induced Chronic Hepatic Injury through Modulating Gut Microbiota

“…Conventional therapies directed against CHI include symptomatic treatment and antibiotics. However, these drugs have side effects that include hepatotoxicity and renal toxicity, and they tend to be less effective in improving liver function [ 7 ]. Traditional Chinese medicine (TCM) has been used for the treatment of CHI for thousands of years [ 8 ].…”