Hepatitis in a United States tertiary referral center.

Galan MV, Potts JA, Silverman AL, Gordon SC.

From the Division of Gastroenterology and Hepatology, William Beaumont
Hospital, Royal Oak, MI.

BACKGROUND/GOALS:: There are limited data regarding the frequency and
proportionality of drug-induced hepatotoxicity in the United States. We
sought to determine the scope of nonfulminant drug-induced hepatitis as
seen
in a community-based hepatology referral service. STUDY:: From a
population
of 4,039 outpatients referred for evaluation of acute (n = 96) and
chronic
(n = 3,943) liver disease over a 10-year period, we reviewed the
records of
those patients diagnosed with acute bona fide drug-induced hepatitis.
RESULTS:: Thirty-two patients presented with self-limited acute
drug-induced
hepatitis, representing 0.8% of all hepatology patients and 33% of
those
patients presenting with acute liver injury. Antibiotics
(amoxicillin/clavulanic acid, minocycline, nitrofurantoin, an
investigational ketolide antibiotic, trimethoprim-sulfamethoxazole, and
trovafloxacin) were the class of drugs most frequently implicated (14
of 32;
44%), while amiodarone was the single agent most commonly associated
with
liver injury (7 of 32; 22%). The mean age of affected patients was 52.2
years, and we found a male predominance (18 of 32; 56%). The mean time
to
biochemical resolution after discontinuation of the offending agent was
14.1
weeks. CONCLUSIONS:: Drug-induced hepatitis is an uncommon entity in
clinical hepatology but does represent a significant proportion of
acute
self-limited liver disease in the United States. Antibiotics and
amiodarone
were the most common drug culprits in our population. Time to
resolution
following the discontinuation of the offending agent may be protracted.
Prospective studies are needed to further assess the burden of
drug-induced
liver injury.

PMID: 15599214 [PubMed - in process]




Sandra Tara Balduf (Ane)

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