title: Resolution of norfloxacin-induced acute liver failure after N-acetylcysteine therapy: further support for the use of NAC in drug-induced ALF?
abstract: Liver injury due to idiosyncratic drug reactions can be difficult to diagnose and may lead to acute liver failure (ALF), which has a high mortality rate. N-acetylcysteine (NAC) is effective treatment for paracetamol toxicity, but its role in non-paracetamol drug-induced ALF is controversial. We report on the use of a validated bedside tool to establish causality for drug-induced liver injury (DILI) and describe the first case of resolution of norfloxacin-induced ALF after NAC therapy. NAC is easy to administer and generally has a good safety profile. We discuss the evidence to support the use of NAC in ALF secondary to DILI and possibilities for further clinical research in this field.
authors.affiliation: University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Timothy Ross
authors.initials: TR
authors.lastname: Elliott
authors.affiliation: Pathology Department, St John of God Hospital, Ballarat, Victoria, Australia.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Symes
authors.affiliation: Ballarat Oncology and Haematology, Ballarat, Victoria, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Kannourakis
authors.affiliation: Victorian Liver Transplant Unit and Department of Gastroenterology, Austin Hospital, Melbourne, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Angus
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D017114:Liver Failure, Acute / Q000139:chemically induced; D009643:Norfloxacin / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D009643:Norfloxacin; D000111:Acetylcysteine