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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
Abstract:
Antimicrobial agents are a common and important cause of hepatotoxicity. As a class, the antimicrobials contain many and varied structures, leading to a wide clinical spectrum of hepatotoxicity. Minor liver injury, manifest only as liver enzyme elevations, is common with some antimicrobials. Clinically significant injury is unusual but can adopt almost any form. Classical acute hepatocellular, cholestatic, or mixed reactions are most often seen. Other forms of hepatotoxicity including granulomatous reactions, steatosis, chronic hepatitis, and cirrhosis have also been described. Generally, antimicrobial-associated hepatotoxicity is mild and self-limited; most cases resolve after withdrawal of the offending medication. Occasionally, however, liver injury presents as a fulminant life-threatening condition or may develop into a chronic illness with significant morbidity. This article presents a summary of reported hepatotoxicity associated with the major classes of antimicrobials and, where possible, identifies potential risk factors and management strategies to assist clinical practice.
Insights
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.