A Patient Case: Intravenous Azithromycin-Induced Hepatotoxicity

Abstract

Objective

To report a case of probable hepatotoxicity associated with intravenous (IV) azithromycin.

Case Summary

A 61-year-old white male was admitted to the hospital with shortness of breath and a subsequent diagnosis of community-acquired pneumonia. The patient's aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were within normal limits. The patient was started on piperacillin/tazobactam 2.25 mg IV every 8 hours and ceftriaxone 1 g IV daily. On day 2 of hospitalization, azithromycin 500 mg IV once daily was initiated. On day 4, the patient's AST increased to 1,594 international units/liter (IU/L) and ALT to 650 IU/L. The ALT/AST peaked on day 6 of hospitalization. The patient's AST and ALT trended downward after discontinuation of the azithromycin.

Discussion

The Naranjo probability scale rated the patient's hepatotoxicity as a probable adverse reaction related to azithromycin toxicity. Two case reports have documented an association with oral azithromycin and hepatotoxicity.

Conclusion

This case report documents an acute increase in ALT and AST levels associated with IV administration of azithromycin. Health care professionals may consider monitoring AST and ALT in patients at risk for hepatic dysfunction with IV administration of azithromycin.