title: Acute liver disease associated with erythromycins, sulfonamides, and tetracyclines.
abstract: OBJECTIVE
  To determine whether erythromycins, sulfonamides, and tetracyclines are associated with an increased risk for acute hepatitis.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Medicaid billing data from Michigan and Florida between 1980 and 1987.
  
  
  METHODS
  The 107 cases included patients hospitalized with acute symptomatic hepatitis without an identifiable cause of liver disease noted in the medical record. Four controls per case were randomly selected and were matched for age, sex, and state.
  
  
  RESULTS
  Five cases (4.7%) and four controls (0.9%) were exposed to erythromycins, yielding an odds ratio of 5.2 (95% Cl, 1.1 to 26.6). No case or control was exposed to erythromycin estolate. Eight cases (7.5%) and three controls (0.7%) were exposed to oral sulfonamides, yielding an odds ratio of 11.4 (Cl, 2.7 to 67.8). All (except one control) had received trimethoprimsulfamethoxazole. Five cases (4.7%) and four controls (0.9%) were exposed to tetracyclines, yielding an odds ratio of 5.2 (Cl, 1.4 to 19.7). The results did not change substantively for erythromycin or sulfonamides after adjustment using multiple logistic regression for age, sex, state, and use of other hepatotoxic drugs. With tetracyclines, however, the odds ratio decreased to 3.6 (Cl, 0.9 to 14.3). Associations were also seen with isoniazid (P = 0.008) and rifampicin (P = 0.04). The number of patients developing acute symptomatic liver disease resulting in hospitalization for each million patients treated with a 10-day course of erythromycin was 2.28 cases; for sulfonamides, this figure was 4.8 cases; and for tetracycline, the figure was 1.56 cases.
  
  
  CONCLUSIONS
  Erythromycin, sulfonamides, and tetracyclines are associated with acute symptomatic hepatitis resulting in hospitalization. Given the widespread use of these drugs, they will be among the more common drugs associated with hepatitis.
authors.affiliation: Division of General Internal Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick 08903.
authors.forename: J L
authors.initials: JL
authors.lastname: Carson
authors.forename: B L
authors.initials: BL
authors.lastname: Strom
authors.forename: A
authors.initials: A
authors.lastname: Duff
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.forename: M
authors.initials: M
authors.lastname: Shaw
authors.forename: F E
authors.initials: FE
authors.lastname: Lundin
authors.forename: K
authors.initials: K
authors.lastname: Das
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016022:Case-Control Studies; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D015986:Confounding Factors, Epidemiologic; D004917:Erythromycin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012306:Risk; D013449:Sulfonamides / Q000009:adverse effects*; D013754:Tetracyclines / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D013449:Sulfonamides; D013754:Tetracyclines; D004917:Erythromycin