Fluoroquinolone-induced liver injury: three new cases and a review of the literature

Abstract

Fluoroquinolones are substantially safe antibiotics. Although fluoroquinolone-related hepatic injury occurs infrequently, its consequences can be severe. Patients should also be cautioned to avoid re-exposure to other members of the fluoroquinolone class.

Risk of hepatotoxicity associated with fluoroquinolones: A national case–control safety study

“…4 With the exception of trovafloxacin, which was removed from the market due to a strong association with fatal acute liver failure, the literature supporting fluoroquinolone-induced hepatotoxicity is scant, mostly limited to case reports and reviews. [5][6][7][8][9][10][11][12][13][14] However, there have been selected reports of death from suspected fluoroquinoloneinduced hepatic failure. [15][16][17] The association between fluoroquinolones and hepatotoxicity remains unclear, and epidemiologic studies are needed to further assess this risk.…”

“…These differences between individual agents may be a result of utilization patterns rather than the agents' hepatotoxic potential. 10 In the United States, the number of prescriptions written for ciprofloxacin from 1996 to 2001 exceeded those for levofloxacin and moxifloxacin by over 40 million and 60 million, respectively. 29 The rates of reporting of acute liver failure to the Food and Drug Administration are similar for several fluoroquinolones; specifically, the cumulative reporting rates for levofloxacin and moxifloxacin were 2.1 and 6.6 per 10 million prescriptions, respectively.…”

“…[25][26][27] Hepatotoxicity with fluoroquinolone exposure may also be a hypersensitivity reaction, as frequent immunologic features and increased injury on reexposure have been described. 10 However, it is likely that fluoroquinolone-related liver toxicity is predominantly idiosyncratic. 10,28 The concept of fluoroquinoloneinduced liver injury as a class effect was supported in a review by the national Drug-Induced Liver Injury Network.…”

“…10 However, it is likely that fluoroquinolone-related liver toxicity is predominantly idiosyncratic. 10,28 The concept of fluoroquinoloneinduced liver injury as a class effect was supported in a review by the national Drug-Induced Liver Injury Network. 9 In that study, fluoroquinolones were listed as a potential cause of hepatotoxicity in 30 cases.…”

Influence of fluoroquinolones on viability of Balb/c 3T3 and HepG2 cells

“…The adverse effects associated with FQs include gastrointestinal effects (nausea, vomiting, diarrhoea), dermatologic effects (phototoxicity), tendinopathy, and CNS reactions (2). The hepatotoxicity of FQs has also been reported (18,19). Although FQs-related hepatic injuries occur infrequently, their consequences can be severe and the mechanism of these effects has not been fully elucidated.…”