Abstract
Idiosyncratic drug-induced liver injury (DILI) is a rare and unpredictable form of hepatotoxicity.
While its clinical course is usually benign, cases leading to liver transplantation
or death can occur. Based on modern prospective registries, antimicrobials including
antibiotics and antifungals are frequently implicated as common causes. Amoxicillin–clavulanate
ranks as the most common cause for DILI in the Western World. Although the absolute
risk of hepatotoxicity of these agents is low, as their usage is quite high, it is
not uncommon for practitioners to encounter liver injury following the initiation
of antibiotic or antifungal therapy. In this review article, mechanisms of hepatoxicity
are presented. The adverse hepatic effects of well-established antibiotic and antifungal
agents are described, including their frequency, severity, and pattern of injury and
their HLA risks. We also review the drug labeling and prescription guidance from regulatory
bodies, with a focus on individuals with hepatic impairment.
Keywords
amoxicillin–clavulanate - DILI - minocycline - ketoconazole - HLA - DRESS
