Hepatotoxicity of antimicrobial, antifungal, and antiparasitic agents

Several antibiotics are known to be hepatotoxic. Apart from subtle, reversible, and often inconsequential abnormalities, cholestasis is the predominant presentation that has a protracted and disabling course. Hepatitis, like illness, is characteristic of some drugs, and chronic liver disease may evolve. It is important to recognize if a patient has an adverse reaction to a drug because continuing use of the drug in the face of hepatitis can have disastrous consequences. Chronic liver disease may ensue and progress onto cirrhosis; this has typically been seen following use of isoniazid and nitrofurantoin. Cholestatic liver disease can progress into a chronic form of a ductopenic state; this is particularly seen after antibiotic-related cholestasis.