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Antibiotic-induced liver toxicity: mechanisms, clinical features and causality assessment

Mercedes Robles1, Elena Toscano, Judith Cotta

  • 1Liver Unit, Gastroenterology Service and Department of Medicine, Vírgen de Victoria University Hospital, University of Málaga, Spain.

Current Drug Safety
|March 10, 2010
PubMed

Insights

Antibiotics can cause liver injury (hepatotoxicity), but the risk is low. Amoxicillin clavulanate and flucloxacillin are common culprits, with genetic factors potentially influencing susceptibility to antibiotic-induced liver damage.

Area of Science:

  • Hepatology
  • Pharmacology
  • Toxicology

Background:

  • Antibiotics are frequently linked to drug-induced liver injury (DILI).
  • Widespread antibiotic use contributes to the high association, though the relative risk remains low.
  • Assessing causality for antibiotic-induced DILI can be challenging due to delayed onset.

Purpose of the Study:

  • To review the landscape of antibiotic-associated hepatotoxicity.
  • To highlight specific antibiotics frequently implicated in DILI.
  • To discuss the patterns, severity, and potential genetic underpinnings of antibiotic-induced liver injury.

Main Methods:

  • Literature review of antibiotic-associated hepatotoxicity.
  • Analysis of causality and patterns of drug-induced liver injury.
  • Inclusion of recent findings on genetic associations with DILI.

Main Results:

  • Amoxicillin clavulanate is the leading cause of antibiotic-related DILI hospitalizations, followed by flucloxacillin.
  • Hepatocellular DILI is generally more severe than cholestatic/mixed types, with age influencing patterns.
  • Telithromycin is a newer macrolide associated with a distinct DILI presentation.
  • Antibiotic-induced DILI is often idiosyncratic, but genetic associations for flucloxacillin and amoxicillin-clavulanate are emerging.

Conclusions:

  • While antibiotic-associated hepatotoxicity is a concern, the overall risk is low.
  • Specific antibiotics like amoxicillin clavulanate and flucloxacillin pose a higher risk.
  • Understanding idiosyncratic reactions and genetic predispositions is crucial for managing antibiotic-induced liver injury.

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