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Cureus. 2021 Oct 21;13(10):e18940. doi: 10.7759/cureus.18940. eCollection 2021 Oct.

Systematic Review of Antifungal-Induced Acute Liver Failure.

Cureus

Eyad Gadour, Ahmed Kotb

Affiliations

  1. Gastroenterology and Hepatology, University Hospitals of Morecambe Bay National Health Service (NHS) Foundation Trust, Lancaster, GBR.
  2. Hepatobiliary Surgery, Glan Clwyd Hospital, Wales, GBR.

PMID: 34703680 PMCID: PMC8529939 DOI: 10.7759/cureus.18940

Abstract

Antifungals are effective antimicrobial agents broadly used in medical practice. Severe acute liver failure from oral or IV administration of antifungals is a rare but long-standing clinical challenge. We aimed to approximate the risk of clinical acute liver injury among users of oral antifungals in the general population. This review was completed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six articles were included, comprising case reports and cohort studies, after eliminating duplicate publications. No randomized control studies were found. In all studies, the duration of antifungal use was associated with significantly increased liver enzyme levels. Although it is not very common for patients on antifungals to develop acute liver failure, the prognosis is often good with swift discontinuation of the drug and proper treatment. Liver function evaluation before treatment and periodic monitoring every three to six weeks after commencement of treatment is suggested.

Copyright © 2021, Gadour et al.

Keywords: acute liver failure; antifungals; drug induced liver injury; fluconazole; hepatotoxicity

Conflict of interest statement

The authors have declared that no competing interests exist.

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