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Hepatotoxicity of antibiotics and antifungals

Michael Thiim1, Lawrence S Friedman

  • 1Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.

Clinics in Liver Disease
|July 26, 2003
PubMed

Insights

Antibiotic-induced liver injury is rare but can occur. Amoxicillin-clavulanate, sulfamethoxazole/trimethoprim, and tuberculosis treatments pose higher risks, necessitating prompt cessation of therapy upon suspicion of hepatic injury.

Area of Science:

  • Hepatology
  • Pharmacology
  • Infectious Diseases

Background:

  • Hepatotoxicity from antibiotics is uncommon but a recognized clinical concern.
  • Widespread antimicrobial use contributes to the incidence of drug-induced liver injury.
  • Penicillins generally exhibit low hepatotoxicity, but specific combinations warrant attention.

Purpose of the Study:

  • To review the spectrum of antibiotic-associated hepatotoxicity.
  • To identify specific antimicrobial agents and combinations with higher risks of liver injury.
  • To emphasize the importance of early diagnosis and management of drug-induced liver injury.

Main Methods:

  • Review of existing literature on antibiotic-induced hepatotoxicity.
  • Analysis of reported cases linking specific antibiotics to hepatic injury.
  • Clinical assessment of risk factors and outcomes associated with antimicrobial drug exposure.

Main Results:

  • Amoxicillin-clavulanate combination shows a notable risk for liver injury.
  • Sulfamethoxazole/trimethoprim and anti-tuberculosis regimens are associated with significant hepatotoxicity.
  • Minocycline, nitrofurantoin, high-dose tetracycline, and oxacillin can cause severe hepatic damage, often resolving upon drug withdrawal.

Conclusions:

  • Early suspicion of antibiotic-induced hepatocellular injury is crucial.
  • Cessation of the offending antimicrobial agent is the primary management strategy.
  • Rechallenge with implicated antibiotics should be strictly avoided to prevent recurrence.

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