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Systematic Review of Antifungal-Induced Acute Liver Failure

Eyad Gadour1, Ahmed Kotb2

  • 1Gastroenterology and Hepatology, University Hospitals of Morecambe Bay National Health Service (NHS) Foundation Trust, Lancaster, GBR.

Cureus
|October 27, 2021
PubMed

Insights

Antifungal medications can cause liver injury, though severe liver failure is rare. Early drug cessation and treatment often lead to good outcomes for patients experiencing adverse liver effects.

Area of Science:

  • Pharmacology
  • Hepatology
  • Clinical Medicine

Background:

  • Antifungals are essential antimicrobial drugs.
  • Severe acute liver failure (SALF) from antifungals is a rare but serious clinical concern.
  • Risk assessment for drug-induced liver injury (DILI) from oral antifungals is needed.

Purpose of the Study:

  • To approximate the risk of clinical acute liver injury (ALI) in the general population using oral antifungals.
  • To review existing literature on antifungal-associated liver injury.
  • To inform clinical practice regarding monitoring and management.

Main Methods:

  • Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
  • Inclusion of six articles: case reports and cohort studies.
  • Exclusion of randomized controlled trials due to limited availability.

Main Results:

  • A significant association was found between the duration of antifungal use and elevated liver enzyme levels across all included studies.
  • While acute liver failure is uncommon, prompt drug discontinuation and appropriate medical management generally result in a favorable prognosis.
  • No randomized controlled trials were identified, limiting the strength of evidence.

Conclusions:

  • Oral antifungals are associated with an increased risk of liver enzyme elevation, with duration of use being a key factor.
  • Prompt recognition and management of drug-induced liver injury are crucial for positive patient outcomes.
  • Pre-treatment liver function assessment and regular monitoring (every 3-6 weeks) are recommended for patients on antifungal therapy.
Keywords:
acute liver failureantifungalsdrug induced liver injuryfluconazolehepatotoxicity

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