In the presence of decompensated cirrhosis, prescribing practices are likely to need altering.Deborah, 54 years of age, presents with concerns about the possibility of high cholesterol. Each scored white tablet contains 100 mg Trimethoprim.Trimethoprim is 5-[(3,4,5-trimethoxyphenyl)methyl]-2,4-pyrimidinediamine. One study 8 comparing nitrofurantoin and trimethoprim revealed no significant difference in recurrence rates or side effects between the two antibiotics, although this involved a lower dose of nitrofurantoin than was used in this case, and a treatment duration of just 6 months. Drug doses should be increased only after clinical examination and biochemical confirmation of stable liver function. There are multiple steps in the drug biotransformation in the liver. Sulfonamides work by preventing the growth of bacteria. Non-alcoholic fatty liver disease encompasses a spectrum of pathologic conditions, ranging from steatosis to steato-hepatitis (NASH) and cirrhosis. This antibiotic can raise liver enzymes more than 5 times the upper limit of normal ranges, but often return to normal without adjusting the dose administered. Tetracyclines rarely affect the liver, except in cases where high doses are administered. Single abnormalities in LFTs are difficult to localise and diagnose . However, in patients with abnormal LFTs in the absence of cirrhosis, drug metabolism is unlikely to be significantly affected.The liver is a primary site of drug metabolism. However, this antibiotic has been ranked within the top 5 to 10 causes of drug-induced liver failure. Tell your doctor if you are pregnant or plan on getting pregnant. An abdominal ultrasound shows mild hepatomegaly with fatty infiltrate but no evidence of cirrhosis or portal hypertension.What is the cause of Deborah’s abnormal LFTs, and is statin therapy appropriate?The most likely cause of Deborah’s abnormal LFTs is non-alcoholic fatty liver disease (NAFLD). She has no significant past history and is taking no prescribed or over-the-counter medications. She rapidly developed jaundice due to nitrofurantoin-induced chronic active hepatitis. Although abnormal tests are thought to be more frequent in patients with atypical pneumonia, the prognostic value of LFTs have not been clearly established.We assessed 96 consecutive patients admitted to one hospital with a chest infection over a period of 6 weeks. Pass rate. However, in patients who do have advanced liver disease there are complex pharmacokinetic and pharmacodynamic considerations. // Leaf Group Lifestyle She drinks 1–2 glasses of wine 2 days per week, her body mass index (BMI) is 31 with a waist circumference of 96 cm. advice about side effects. Many diseases and conditions can contribute to elevated liver enzymes. The pattern of liver function tests (LFTs) in community-acquired pneumonia has not been investigated in detail. She specializes in health and nutrition articles. Hepatic synthetic function, assessed by measurement of INR and albumin, is preserved. Learn about the possible causes of elevated liver enzymes and their symptoms and treatment options here. There is no stigmata of chronic liver disease on examination. For a short summary of deranged LFT interpretation, one cannot do better than the LITFL page by Mike Cadogan. Her brother, aged 58 years, has displipidaemia and symptomatic coronary heart disease, but there is no other family history of cardiac disease. Trimethoprim is a synthetic antibacterial available in tablet form for oral administration. Her work has appeared in various health Web sites. All vivas related to this topic. Destiny holds a Bachelors of Science in nursing from Boston University and a Master of Public Health Nutrition from Tufts University. The most likely cause of Deborah’s abnormal LFTs is non-alcoholic fatty liver disease (NAFLD). Copyright © 2020 Leaf Group Ltd., all rights reserved. The pattern of liver function tests (LFTs) in community-acquired pneumonia has not been investigated in detail. You may also report side effects at https://www.fda.gov/medwatch. Abdominal ultrasound is useful if there are ultrasound features of portal hypertension (splenomegaly, enlarged main portal vein, ascites, recanalisation of the paraumbilical vein or the presence of porto-systemic shunts). TMP-SMZ can mildly elevate liver enzymes without leading to severe liver injury. help if any of these side effects or any other side effects bother you or do not go away: