Antibiotics: Single Largest Class Of Drugs Causing Liver Injury

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Antibiotics: Single Largest Class Of Drugs Causing Liver Injury

_http://www.sciencedaily.com/releases/2008/12/081201081904.htm_

(http://www.sciencedaily.com/releases/2008/12/081201081904.htm)

 

ScienceDaily (Dec. 8, 2008) — Antibiotics are the single largest class of

agents that cause idiosyncratic drug-induced liver injury (DILI), reports a

new study in Gastroenterology, an official journal of the American

Gastroenterological Association (AGA) Institute. DILI is the most common cause

of

death from acute liver failure and accounts for approximately 13 percent of

cases of acute liver failure in the U.S.

It is caused by a wide variety of prescription and nonprescription

medications, nutritional supplements and herbals.

**DILI is a serious health problem that impacts patients, physicians,

government regulators and the pharmaceutical industry, " said Naga P. Chalasani,

MD, of the Indiana University School of Medicine and lead author of the

study. " Further efforts are needed in defining its pathogenesis and

developing means for the early detection, accurate diagnosis, prevention and

treatment of DILI.**

 

In this prospective, ongoing, multi-center observational study — the

largest of its kind — patients with suspected DILI were enrolled based upon

predefined criteria and followed for at least six months. Those with

acetaminophen liver injury were excluded.

Researchers found that DILI was caused by a single prescription medication

in 73 percent of the cases, by dietary supplements in 9 percent and by

multiple agents in 18 percent. More than 100 different agents were associated

with DILI; antimicrobials (45.5 percent) and central nervous system agents

(15 percent) were the most common. Of the dietary supplements causing DILI,

compounds that claim to promote weight loss and muscle building accounted

for nearly 60 percent of the cases. The study found that at least 20 percent

of patients with DILI ingest more than one potentially hepatotoxic agent.

DILI remains a diagnosis of exclusion and thus detailed testing should be

performed to exclude competing causes of liver disease; importantly, acute

hepatitis C virus (HCV) infection should be carefully excluded in patients

with suspected DILI by HCV RNA testing. Researchers found no relationship

between gender and severity of DILI, but individuals with diabetes

experienced more severe DILI.

This study is an initial analysis of an ongoing prospective study of DILI.

Its primary aim is to develop well-characterized cases of

medication-related liver injury on which to conduct hypothesis-driven research

targeted at

developing means to diagnose, prevent and treat DILI. DILI is the most

frequent adverse drug-related event leading to abandonment of potentially

promising new drug candidates during pre-clinical or clinical development,

failure to achieve drug approval, and withdrawal or restriction of prescription

drug use after approval.