Retrospective analysis of clinical features of liver injury induced by levofloxacin
Abstract
BACKGROUND
Current understanding of the relationship between levofloxacin exposure and hepatic injury primarily relies on case reports. This article aims to investigate the features of levofloxacin-induced liver injury.
RESEARCH DESIGN AND METHODS
We incorporated case series and reports regarding levofloxacin-induced hepatotoxicity published prior to 30 June 2024, utilizing an extensive search database. The data from 40 patients were collected and subjected to descriptive analysis.
RESULTS
The median age of the 40 patients was 60 years (range 10, 99), and the median time to exacerbation was 5 days (range 1 199). Liver injury was categorized as hepatocellular (62.5%), cholestatic (12.5%), and mixed (25.0%). Clinical manifestations included asymptomatic elevations in liver enzymes, jaundice, dark urine, nausea, vomiting, anorexia, hepatic encephalopathy. Laboratory evaluations revealed varying degrees of elevation in aminotransferases and total bilirubin. Biopsy results indicated hepatic necrosis, cholestasis, steatosis, and inflammatory infiltrates. After levofloxacin discontinuation, the median time to normalization of liver function was 21 days (range 3, 103), and 8 patients ultimately succumbing to the condition.
CONCLUSIONS
Hepatotoxicity is an uncommon but severe adverse effect associated with levofloxacin. Immediate discontinuation of levofloxacin is warranted if there is a rapid increase in aminotransferase levels or the emergence of hepatitis symptoms.
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 40 participants or records.
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