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Updated: Jun 27, 2026
11:17
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
[Hepatotoxicity by antibiotics: update in 2008]
1Servicio de Aparato Digestivo, Unidad de Hepatologia, Hospital Universitario Virgen de la Victoria, Malaga, Espana.
Summary
Antibiotics can cause liver injury (hepatotoxicity), with amoxicillin-clavulanate being a leading culprit. While rare, understanding drug-induced liver injury patterns is crucial for patient care.
Area of Science:
- Pharmacology
- Hepatology
- Toxicology
Background:
- Antibiotics are frequently implicated in drug-induced liver injury (DILI).
- Despite frequent use, the absolute risk of antibiotic-associated hepatotoxicity is generally low.
- Amoxicillin-clavulanate is a significant cause of DILI-related hospitalizations.
Purpose of the Study:
- To review the spectrum of hepatotoxicity associated with commonly prescribed antibiotic classes.
- To highlight specific antibiotic agents and their characteristic liver injury patterns.
- To inform clinicians about the potential for DILI from various antibiotic classes.
Main Methods:
- Literature review of antibiotic-induced hepatotoxicity.
- Analysis of case reports and cohort studies on DILI.
- Examination of clinical presentations and injury patterns associated with specific antibiotics.
Main Results:
- Amoxicillin-clavulanate is the leading cause of DILI, accounting for 12.8-14% of cases, with an incidence of 9.91 per 100,000 users.
- Hepatotoxicity presentation varies by age: hepatocellular injury in younger patients, cholestatic/mixed in older patients.
- Macrolides (e.g., erythromycin, telithromycin) and tetracyclines (e.g., minocycline) can cause distinct liver injury patterns, while quinolones rarely cause hepatotoxicity.
Conclusions:
- Amoxicillin-clavulanate poses a significant risk for DILI, necessitating careful monitoring.
- Different antibiotic classes exhibit unique hepatotoxic profiles, influenced by patient age and drug properties.
- Awareness of antibiotic-induced liver injury is essential for timely diagnosis and management.
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