Clinical and laboratory diagnostics of drug-induced liver injury by antibiotics

Abstract

Liver damage in a patient can precede the prescribing of antibiotics for the treatment of an infectious disease, may occur during their use or after their discontinuation. Liver damage before the start of treatment limits the choice and affects the dosage of antimicrobial agents. The occurrence of liver damage during antimicrobial treatment or after discontinuation of antibiotics can be both a consequence of this intake and independent of treatment with antibacterial drugs. Diagnosis of such lesions requires the use of many clinical, laboratory and instrumental investigations. The key element of diagnosis is the determination of the biochemical variant of liver damage, which makes it possible to plan the sequence of differential diagnosis. In case of suspicion of drug-induced damage to the liver, it is necessary to stop taking immediately the drugs that allegedly caused it. The next step is finding out the connection between the use of the antibiotic and the occurrence of the disease, taking into account the data of the literature regarding this possibility. Then it is necessary to estimate compatibility in time between the start of the use of drugs and the appearance of signs of liver damage, to assess the severity of the injury and, if possible, to prescribe appropriate medicines. There are several methods to assess causality between drugs and liver injury with RUCAM on the head. LiverTox is a well-known database on medicines, which are capable to cause liver damage. Antimicrobial agents belong to the most frequent causes of drug-induced liver injury. Most of such injuries are idiosyncratic. There was used a clinical example of possible drug-induced liver damage to illustrate decisions and difficulties in proving the etiological role of an antibiotic in a case, when liver damage arose during management of a patient with community-acquired pneumonia. This artic­le is a clinical lecture. Keywords: toxic action, biochemical variant, antimicrobials.