Objective  To analyze the characteristics of black hairy tongue induced by antibacterial drugs and provide reference for rational drug use.

Methods  PubMed, Web of Science, WanFang Data and CNKI databases were searched to collect literatures on the occurrence of black hairy tongue associated with antibacterial drugs, and the following information of patients including the gender, age, underlying disease, site of infection, suspected antibacterial drugs, co-administration of antimicrobial drugs, adverse drug reaction symptoms, induction time, treatment measures, outcome time, and possible inducing factors were statistically analyzed.

Results  A total of 38 cases (from 26 articles) were collected, of which 24 were male, with the minimum age of the patients being 5 years and the maximum age being 83 years. 22 cases had chronic underlying diseases (57.9%); 26 cases (68.4%) had black hairy tongue, and 12 cases (31.6%) had black tongue. Among the antibacterial drugs suspected of causing black hairy tongue, linezolomide was present in 24 cases (63.2%) and metronidazole in 4 cases (10.5%); 26 cases (68.4%) were induced within 2 weeks, and there was no significant difference between linezolid and metronidazole in induction time (P>0.05); 28 cases (73.7%) disappeared within 3 weeks, and no significant difference was found in the outcome time between immediate drug withdrawal and withdrawal after full course (P>0.05).

Conclusion The study shows that black hairy tongue is more likely to occur in males older than 50 years old with underlying diseases such as malignant tumors and autoimmune diseases, and patients who have been using antibiotics extensively for a long time. Linezolid and metronidazole are more susceptible to adverse reactions in antibacterial drugs, and the black hairy tongue appears from the first two weeks of drug treatment and disappears within three weeks of drug withdrawal. Therefore, clinicians and pharmacists should strengthen pharmaceutical care and explanation to relieve patients’ anxiety.

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