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Updated: Jun 3, 2026

Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
11:06

Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro

Published on: January 31, 2022

Severe hepatotoxicity associated with the combination of spiramycin plus metronidazole

Rola Hussein1, Mustapha El-Halabi, Ola Ghaith

  • 1Division of Gastroenterology, Department of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

Arab Journal of Gastroenterology : the Official Publication of the Pan-Arab Association of Gastroenterology
|March 25, 2011
PubMed

Insights

Drug-induced liver injury (DILI) from antibiotics is common. This study details four cases of severe liver injury caused by spiramycin and metronidazole, highlighting the need for vigilance.

Area of Science:

  • Hepatology
  • Pharmacology
  • Infectious Diseases

Background:

  • Drug-induced liver injury (DILI) is a significant cause of acute liver failure and drug withdrawals.
  • Antibiotics are frequently implicated in DILI, presenting a wide spectrum of liver damage.
  • Periodontal infections are commonly treated with antibiotic combinations.

Observation:

  • Four patients developed moderate to severe liver injury after taking spiramycin and metronidazole.
  • No alternative causes for liver injury were identified in these patients.
  • The clinical course varied, with two patients recovering spontaneously.

Findings:

  • Two patients experienced severe hepatotoxicity, one requiring immunosuppressants (corticosteroids and mycophenolate mofetil).
  • One patient with severe DILI necessitated a liver transplant due to subacute massive necrosis.
  • Spiramycin and metronidazole combination therapy was linked to significant liver injury.

Implications:

  • This case series underscores the potential hepatotoxicity of the spiramycin-metronidazole combination.
  • Clinicians should consider DILI when evaluating liver injury in patients using these antibiotics.
  • Further research into the mechanisms and risk factors for antibiotic-induced liver injury is warranted.

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