title: Fluoroquinolone-induced liver injury: three new cases and a review of the literature.
abstract: OBJECTIVE
  Fluoroquinolones are popular and widely used in primary care and hospital settings. Premarketing studies showed a favourable side-effect profile. However, significant morbidity and the need for liver transplantation for acute liver failure have been reported. We reviewed the available data on liver damage linked to fluoroquinolones.
  
  
  METHODS
  A systematic search of case reports on the MEDLINE database encompassing the years 2000-2011 was carried out. Additional references were found by a manual search of the retrieved paper. We also describe three new cases of hepatotoxicity attributable to fluoroquinolones seen at our Unit.
  
  
  RESULTS
  Thirty-five cases were retrieved from MEDLINE (51.4% male). According to the RUCAM scale, liver injury was classified as hepatocellular (51.4%), cholestatic (28.6%) or mixed (20.0%). Older age (≥ 65 years) was present in 42.8%. The time between initiation of treatment and hepatic injury ranged from 1 to 39 days (median 8 days). According to the RUCAM score, our cases were classified to be "highly probable" or "probable". Only one patient underwent liver biopsy, which showed the features of liver damage linked to drug exposure. Liver enzymes from all patients return to normal range within 4 weeks of withdrawal. Only one patient showed a renal failure, associated with liver injury, with a need for haemodialysis for 3 weeks.
  
  
  CONCLUSIONS
  Fluoroquinolones are substantially safe antibiotics. Although fluoroquinolone-related hepatic injury occurs infrequently, its consequences can be severe. Patients should also be cautioned to avoid re-exposure to other members of the fluoroquinolone class.
authors.affiliation: Sezione e UOC di Gastroenterologia, DiBiMIS, Università di Palermo, Palermo, Italy. annalisalicata@yahoo.com
authors.forename: Anna
authors.initials: A
authors.lastname: Licata
authors.forename: Claudia
authors.initials: C
authors.lastname: Randazzo
authors.forename: Ilaria
authors.initials: I
authors.lastname: Morreale
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Butera
authors.forename: Natale
authors.initials: N
authors.lastname: D'Alessandro
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D024841:Fluoroquinolones / Q000009:adverse effects*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones