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Hepatotoxicity of antimicrobial agents
Steven John Brown1, Paul Vincent Desmond
1Department of Gastroenterology, The University of Melbourne, St. Vincent's Hospital, Victoria, Australia. brownst@svhm.org.au
Seminars in Liver Disease
|May 23, 2002
Summary
Antimicrobial drugs can cause liver injury (hepatotoxicity), ranging from mild enzyme changes to severe, life-threatening conditions. Most antimicrobial-associated liver damage is reversible upon drug discontinuation.
Area of Science:
- Hepatology
- Pharmacology
- Toxicology
Background:
- Antimicrobial agents are frequently implicated in drug-induced liver injury (DILI).
- The diverse structures of antimicrobials contribute to a broad spectrum of hepatotoxicity.
- While often mild and self-limiting, antimicrobial hepatotoxicity can occasionally be severe or chronic.
Purpose of the Study:
- To summarize reported hepatotoxicity associated with major antimicrobial classes.
- To identify potential risk factors for antimicrobial-associated liver injury.
- To outline management strategies for clinical practice.
Main Methods:
- Literature review of reported cases of antimicrobial-associated hepatotoxicity.
- Analysis of clinical presentations and outcomes.
- Identification of risk factors and treatment approaches.
Main Results:
- Antimicrobial-associated hepatotoxicity manifests in various forms, including hepatocellular, cholestatic, mixed, granulomatous, steatotic, chronic hepatitis, and cirrhosis.
- Minor liver enzyme elevations are common with certain antimicrobials.
- Severe or fulminant liver injury and chronic liver disease are less common but significant complications.
Conclusions:
- Antimicrobial-associated hepatotoxicity is a significant clinical concern with diverse presentations.
- Early recognition and drug withdrawal are crucial for managing antimicrobial-induced liver injury.
- Understanding risk factors and management strategies can improve patient outcomes.