Serranti Daniele, Montagnani Carlotta, Indolfi Giuseppe, Chiappini Elena, Galli Luisa, de Martino Maurizio
University of Florence, Florence, Italy.
J Chemother. 2013 Oct;25(5):255-72. doi: 10.1179/1973947813Y.0000000090.
Antimicrobial agents are important causes of drug-induced liver injury. They are responsible for about 45% of cases of drug hepatotoxicity. Hepatic damage mechanisms are intrinsic or idiosyncratic. Usually, antibiotics are responsible for idiosyncratic toxicity. This review summarizes the rate of incidence and clinical features of hepatotoxicity due to antibiotics and chemotherapics, with particular attention to data regarding paediatric population. Liver injury features have been systematically evaluated for the most commonly administered antibiotics and chemotherapics in adults, even though there is little information about other widely used compounds, as cephalosporine or clarithromycin, and about antibiotics active against multi-resistant bacteria, as carbapenems, vancomycin, clindamycin, and linezolid. By contrast, there is an abundance of case reports in paediatrics, but very few structured studies have been carried out in children. Children are an important class of antibiotic users, with specific metabolic characteristics, so more studies on them should be carried out.
抗菌药物是药物性肝损伤的重要原因。它们约占药物性肝毒性病例的45%。肝损伤机制分为内在性或特异质性。通常，抗生素导致特异质性毒性。本综述总结了抗生素和化疗药物所致肝毒性的发生率及临床特征，尤其关注儿科人群的数据。尽管对于其他广泛使用的化合物（如头孢菌素或克拉霉素）以及对多重耐药菌有活性的抗生素（如碳青霉烯类、万古霉素、克林霉素和利奈唑胺）的信息较少，但已对成人中最常用的抗生素和化疗药物的肝损伤特征进行了系统评估。相比之下，儿科有大量病例报告，但针对儿童开展的结构化研究却很少。儿童是抗生素的重要使用群体，具有特定的代谢特征，因此应开展更多针对他们的研究。
