Brief communication: severe hepatotoxicity of telithromycin: three case reports and literature review.
BACKGROUND
Telithromycin is a ketolide antibiotic approved by the U.S. Food and Drug Administration for acute bacterial infections causing sinusitis, bronchitis, and community-acquired pneumonia.


OBJECTIVE
To describe 3 cases of severe hepatotoxicity in patients receiving telithromycin.


METHODS
Case reports.


METHODS
A tertiary care medical center.


METHODS
3 previously healthy patients who had recently taken telithromycin and took no other prescription medications.


METHODS
Serologic, histologic, and liver function tests.


RESULTS
Within a few days of receiving telithromycin, the patients presented with acute hepatitis. All had jaundice and markedly abnormal results on liver function tests. Results of viral serologic tests were negative. One patient spontaneously recovered, 1 required orthotopic liver transplantation, and 1 died. Histologic examination in the latter 2 patients showed massive hepatic necrosis.


CONCLUSIONS
Two patients had some history of alcohol use. The frequency of severe telithromycin-related hepatotoxicity cannot be established with case reports.


CONCLUSIONS
Telithromycin can cause severe hepatotoxicity. Caution is advised in prescribing this drug pending additional postmarketing surveillance data.
Carolinas Medical Center, Charlotte Gastroenterology and Hepatology, Carolinas HealthCare System, and Carolinas Pathology Group, Charlotte, North Carolina 28203, USA. kimberly.clay@carolinashealthcare.org
Kimberly D
KD
Clay
John S
JS
Hanson
Scott D
SD
Pope
Richard W
RW
Rissmiller
Preston P
PP
Purdum
Peter M
PM
Banks
D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D048628:Ketolides / Q000009:adverse effects*; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011500:Protein Synthesis Inhibitors / Q000009:adverse effects*
D000900:Anti-Bacterial Agents; D048628:Ketolides; D011500:Protein Synthesis Inhibitors; C106791:telithromycin