Antibiotics and Chronic Liver Diseases

Chronic hepatitis patients sometimes need to use antibiotics for unrelated infections and various surgical and dental procedures. Many are not sure about the possible harmful effects some antibiotics may cause their liver so I will try to provide a general guide here.

The liver has very complicated functions and one of the most important is the detoxification of drugs such as antibiotics and its metabolites. Some antibiotics can cause allergic reactions while others can cause direct damage to their liver, which can be quite severe in patients with chronic liver disease. For patients with a pre-existing liver disorder, the detoxification function of the liver is already compromised and substances that would normally be metabolized could actually accumulate in the liver or in the bloodstream. Antibiotics that accumulate in this manner could become toxic to the body and its functions can change drastically from its original purpose.

The following is a list of the most common antibiotics groups being used today. Each is ordered according to their potential harmful effects on the liver, the top group being the most potentially harmful and the last group being the least.

1. Tetracycline family

The following antibiotics belong to this family: Tetracycline, Minocylinum, Guamecycline, Oxytetracycline, Doxycyline, Methacycline, and Demethylchlortetracycline. When used in larger doses, antibiotics in this family can cause jaundice, fever, and fatty liver. Hepatitis patients should be very wary of this group and alert their doctor immediately of their liver condition and ask for substitutes.

2. Erythromycin family

The following antibiotics belong to this family: Erythromycin, Erythromycin Estotate, Erythromycin ethylsuccinate. These antibiotics can cause damage to the liver via cholestasis (bile retention) and jaundice. The harmful effects usually start to show after 10 to 14 days’ use and the incidence rate is approximately 5 to 10%. Clinically, patients may experience stomachache, nausea, vomiting, jaundice, and elevation of liver enzymes. These conditions are often considered allergic reactions since the incidence rate is not very high.

3. Chloramphenicolum family.

The following antibiotics belong to this family: Chloramphenicolum, Chloramphenicol Palmitate, Thiamphenicol and Chloramphenicoli Succinas. When metabolized in the liver, they combined with glucoronic acid and lose their anti-microbial effects. This combination of antibiotics and glucoronic acid can accumulate in the bloodstream, which can cause bone marrow inhibition. As a result, WBC and RBC counts can drop and patients with hepatitis should try to avoid this group if they can.

4. Penicillin family.

The following antibiotics belong to this family: Benzylpenicillin, Benzathine penicillin, Phenoxymethylpenicillin, Oxacillin Sodium, Cloxacillin, Dicloxacillin, Ampicillin Sodium, Ampicloxacillin sodium, Pvampicillin, Amoxicillin, Carbenicillin sodium, Talampicillin, Furbenicillin, Mecillinam, Carindacillin sodium, Ticarcillin. These antibiotics cause the least liver damage and only patients who are allergic may experience some side effects. Generally, antibiotics in the penicillin family are the most "liver friendly" and safe for chronic hepatitis patients to use.