Ceftriaxone-induced hepatotoxicity in patients with common medical infections in Qatar: A retrospective study

Manish Barman; Bassem Al Hariri; Abdul Rahman Mustafa; Naseem Ambra; Israa Amjed; Ahmad Eid Nazzal Alharafsheh; M N Illahi; S Hamuda; Mohamedali Gaafar; Muhammad Sharif

doi:10.5339/qmj.2022.27

Ceftriaxone-induced hepatotoxicity in patients with common medical infections in Qatar: A retrospective study

Qatar Med J. 2022 Jul 7;2022(3):27. doi: 10.5339/qmj.2022.27. eCollection 2022.

Authors

Manish Barman^{1

2}, Bassem Al Hariri¹, Abdul Rahman Mustafa¹, Naseem Ambra¹, Israa Amjed¹, Ahmad Eid Nazzal Alharafsheh¹, M N Illahi^{1

2}, S Hamuda¹, Mohamedali Gaafar^{1

2}, Muhammad Sharif^{1

2}

Affiliations

¹ Department of Medicine, Hamad Medical Corporation, Doha, Qatar E-mail: drbarman@yahoo.com.
² Department of Clinical Medicine, Weill Cornell Medicine, Qatar.

Abstract

Introduction: Ceftriaxone, a third-generation cephalosporin, is frequently used for the treatment of various bacterial infections as a broad-spectrum antibiotic for many decades. Although ceftriaxone is a well-tolerated drug in most cases, it can lead to serious liver injury, which can be a real challenge to the treating physician. Given the potentially serious adverse effects that can vary from mild biochemical abnormalities to complete liver failure, we intend to assess the spectrum of liver injury based on biochemical criteria for patients treated with ceftriaxone for common bacterial infections in Qatar.

Objectives: This study aimed to explore the incidence of ceftriaxone-induced liver injury at Hazm Mebaireek General Hospital, Qatar, and to evaluate the relationship of the ceftriaxone dose, if any, with liver dysfunction.

Methods: This retrospective study included hospitalized adult patients treated with ceftriaxone at our hospital from January 2019 to December 2019 and analyzed demographic and clinical data obtained from electronic medical records. This study determined the incidence of liver injury (primary outcome) in patients treated with ceftriaxone (2 g/day) for ≥ 2 consecutive days by reviewing liver function test results until the day of discharge and at the first outpatient follow-up.

Results: The final data analysis included a total of 634 patients admitted and treated with ceftriaxone from January 2019 to December 2019.In the multivariate analysis with propensity score adjustment, ceftriaxone was independently associated with liver injury, especially when combined with other agents utilizing hepatic metabolism.

Conclusions: Ceftriaxone was associated with a significantly higher incidence of liver injury (19.7%) when used along with other medications that are metabolized in the liver, as found in the present study compared with other similar studies (approximately 2.9%-13.9%). Furthermore, the incidence was too high to be ignored in clinical practice.

Keywords: Ceftriaxone; Drug-induced liver injury; drug-induced cholestasis; drug-induced hepatitis.