title: Severe hepatotoxicity associated with the combination of spiramycin plus metronidazole.
abstract: Drug-induced liver injury (DILI) is a leading cause of acute liver failure and is the most frequent reason for post-marketing drug withdrawal. The spectrum of liver injury is wide, ranging from mild and subclinical injury, noticeable only on routine biochemical testing, to fulminant liver failure and death. Antibiotics, as a group, are a leading cause of DILI. We herein describe 4 patients who developed moderate to severe hepatotoxicity after exposure to a commercially - available combination of two antibiotics - spiramycin and metronidazole - commonly used for the treatment and prevention of periodontal infections. No other aetiology for liver injury could be identified in all cases. Two patients recovered spontaneously, and two had a more severe course, one responding to corticosteroids and mycophenolate mofetil and the other requiring liver transplantation for subacute massive necrosis.
authors.affiliation: Division of Gastroenterology, Department of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Rola
authors.initials: R
authors.lastname: Hussein
authors.forename: Mustapha
authors.initials: M
authors.lastname: El-Halabi
authors.forename: Ola
authors.initials: O
authors.lastname: Ghaith
authors.forename: Nawaf
authors.initials: N
authors.lastname: Jurdi
authors.forename: Cecilio
authors.initials: C
authors.lastname: Azar
authors.forename: Nabil
authors.initials: N
authors.lastname: Mansour
authors.forename: Ala I
authors.initials: AI
authors.lastname: Sharara
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000981:Antiprotozoal Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D004338:Drug Combinations; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008795:Metronidazole / Q000009:adverse effects*; D015572:Spiramycin / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000981:Antiprotozoal Agents; D004338:Drug Combinations; D008795:Metronidazole; D015572:Spiramycin; C039503:Rodogyl