A 75-year-old man developed a biopsy-proven, drug-induced intrahepatic cholestasis after use of amoxycillin trihydrate combined with the beta-lactam inhibitor potassium clavulanate (Augmentin). Cholestatic liver injury is an uncommonly recognized, probably immunologically based adverse reaction to therapy with penicillin and its derivatives.
Sir, Response to Jones et alWe note with interest the paper by Jones et al regarding the role of General Practitioners with specialist interests (GPwSI) in reducing the high false-positive rate of referrals for glaucoma. 1 They maintain that the reduced false-positive rate in their study translates into improved efficiency. However, efficiency is characterised by maximum effectiveness with minimum waste of resources. Measurement of efficiency would also require demonstration of a reduced false-negative rate. It would be of interest to know how many of the patients discharged by the GPwSI would also have been discharged by the glaucoma specialist. Reference 1 Jones LD, Robinson R, Cook NJ. General practitioner with a special interest improves the efficiency of glaucoma referrals. Eye 2006; 20: 942.
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