Poster (15W186)

Risk of acute liver injury associated with misuse of antibiotics

Author(s)

Aman Yadav1, Jawad Rasool, John Keohane, Subhasish Sengupta

Department(s)/Institutions

Gastroenterology Department, Our Lady of Lourdes Hospital, Drogheda, Co. Louth

Introduction

Antibiotics are the most common cause of DILI (Drug induced liver injury) with an incidence of 5/100,000. [1] Antibiotics particularly containing beta-lactamase inhibitor like Piperacillin/ Tazobactam combination and Co-amoxiclav puts the patients at increased risk with Co-amoxiclav being the leading cause of DILI accounting for 32% of all cases with an incidence of 9.1/100,000. [2] Co-amoxiclav is also the leading cause of hospitalization for adverse hepatic events and increases the risk 5- 10 times as compared to amoxicillin alone with an adjusted odds ratio versus non-use at 31.9 for recent use and 94.8 for current use. [2] On the other hand antibiotics such as amoxicillin (adjusted odds ratio 1.7), fluoroquinolones (adjusted odds ratio 1.2), and macrolides are rarely shown to cause DILI. Females and elderly (age >65) are at higher risk of DILI. [3]

Aims/Background

The aim of the study was to assess if misuse of antibiotics in respiratory tract infections can put patients at increased risk of liver injury.

Method

In this retrospective single centre study, we identified all patients who presented with respiratory tract infection to ED and AMAU between 1st March 2015 and 31st March 2015. From chart review patient details, history, examination, investigations, blood results and antibiotic prescribed were recorded. From the collected data CURB-65 score was calculated on the individual patients. Hospital antibiotic guidelines were then used to ascertain the appropriateness of the antibiotic usage. Only patients on whom hospital chart was available were included in the study.

Results

Demographics: In total 88 patients (male: 32, female: 56) were included in this study of which 49 (55.7%) patients were admitted to the hospital. Age range was: 19 – 95, Mean Age: 66.34. Etiology: Mild infection (CURB 0-1): 63 (71.6%), Moderate (CURB 2): 21 (21.9%), Severe (CURB 3-5): 4 (4.5%). As per hospital antibiotic guidelines, patients with mild and moderate pneumonia should be treated with amoxicillin or/ and Clarithromycin. However out of 84 patients with mild and moderate infection in our study, 65 (77.4%) received Co-amoxiclav or Pip/Tazo combination antibiotic putting patients at an increased risk of developing DILI. Of 34 patients in the high-risk group (female >65), 31 had mild infection but 25 (73.5%) of these received Coamoxiclav or Pip/Tazo combination again putting patients at increased risk of DILI.

Conclusions

Respiratory tract infections represent the most common acute illness evaluated in outpatient setting. So its imperative the local guidelines are followed in treating these infections as misuse of antibiotics can put patients at an increased risk of developing DILI.