Antibiotics and liver - A review of the complicated relationship
Keywords:Selective intestinal decontamination, acute on chronic liver failure, positive effects, negative effects, children, antimicrobial stewardship, antibiotic associated liver disorders
Many antibiotics used to treat bacterial infections and to treat disorders of the liver, gallbladder and bile ducts. However, their irrational use leads to liver injury. Drug induced liver injury is the most difficult diagnosis to be established and should be differentiated from other diseases with similar conditions. Recovery occurs by withdrawal of the offending drug. Selective intestinal decontamination can be done to prevent infections resulting as a complication of cirrhosis. In children, diagnosis is challenging because of absence of specific markers. Irrational antibiotic use is the leading cause for emergence of multidrug-resistant strains of bacteria. Deriving an early and rational antibiotic therapy is essential. Antibiotics have a positive effect in diseases such as Acute on Chronic Liver Failure, cirrhosis, Portal bacteremia, etc. Short antibiotic treatment courses, early de-escalation, high doses and use of continuous or extended infusions for time-dependent antibiotics are some of the measures to help reduce resistance. The severity of injury ranges from asymptomatic to severe stage disease. In pediatric population there is varied presentation of symptoms for various antibiotic induced liver injuries and diagnosis is difficult due to age-dependent factors.
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