A rare case of hepatitis associated with cefprozil therapy

Bılıcı, Ahmet; Karaduman, Mehmet; Çankir, Zeki

doi:10.1080/00365540600823235

Cited by 14 publications

(9 citation statements)

References 15 publications

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“…14,15 A newer third-generation cephalosporin, cefproxil, similar to cefdinir in its pharmacokinetics and adverse effect profile has been associated with hepatitis. 16 Cephalosporins are not typically known to be hepatotoxic; therefore the mechanism continues to be poorly understood, although hypersensitivity has been postulated. 17 In all these cases, jaundice was mild and self-limited upon the discontinuation of the therapy, though it took several weeks to improve.…”

Section: Discussionmentioning

confidence: 98%

Cefdinir-Induced Hepatotoxicity: Potential Hazards of Inappropriate Antibiotic Use

Chen

Ahmad

2008

J GEN INTERN MED

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Drug-induced hepatotoxicity is well recognized but can cause some diagnostic problems, particularly if not previously reported. The present case involves a 22-year-old male who presented with jaundice and elevated liver enzymes after a course of cefdinir (Omnicef) for streptococcal pharyngitis. A diagnosis of drug-induced liver injury was suspected but a liver biopsy was required after his jaundice worsened despite cessation of the presumed offending agent. A short course of steroids was initiated and eventually the jaundice resolved. This case highlights the need to suspect medication-induced liver injury in cases of jaundice, even if not previously reported. In addition, it illustrates the potential for adverse outcomes in situations where antibiotics are used inappropriately or where first line antibiotics are not used for routine infections. We report a case of a young male who developed jaundice associated with cefdinir use with pathological confirmation of moderate cholestasis with portal and lobular mixed inflammation and focal bile duct injury consistent with drug-induced liver injury.

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Section: Discussionmentioning

confidence: 98%

Cefdinir-Induced Hepatotoxicity: Potential Hazards of Inappropriate Antibiotic Use

Chen

Ahmad

2008

J GEN INTERN MED

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“…64–67 Cholestasis featured in all documented cases of cephalosporin-associated hepatotoxicity, with symptoms manifesting within a few days of treatment. With the exception of ceftriaxone, for which a specific mechanism has been identified, hepatotoxicity appears to be immunologically mediated.…”

Section: β-Lactamsmentioning

confidence: 99%

Hepatic safety of antibiotics used in primary care

Andrade

Tulkens

2011

Journal of Antimicrobial Chemotherapy

167

138

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Antibiotics used by general practitioners frequently appear in adverse-event reports of drug-induced hepatotoxicity. Most cases are idiosyncratic (the adverse reaction cannot be predicted from the drug's pharmacological profile or from pre-clinical toxicology tests) and occur via an immunological reaction or in response to the presence of hepatotoxic metabolites. With the exception of trovafloxacin and telithromycin (now severely restricted), hepatotoxicity crude incidence remains globally low but variable. Thus, amoxicillin/clavulanate and co-trimoxazole, as well as flucloxacillin, cause hepatotoxic reactions at rates that make them visible in general practice (cases are often isolated, may have a delayed onset, sometimes appear only after cessation of therapy and can produce an array of hepatic lesions that mirror hepatobiliary disease, making causality often difficult to establish). Conversely, hepatotoxic reactions related to macrolides, tetracyclines and fluoroquinolones (in that order, from high to low) are much rarer, and are identifiable only through large-scale studies or worldwide pharmacovigilance reporting. For antibiotics specifically used for tuberculosis, adverse effects range from asymptomatic increases in liver enzymes to acute hepatitis and fulminant hepatic failure. Yet, it is difficult to single out individual drugs, as treatment always entails associations. Patients at risk are mainly those with previous experience of hepatotoxic reaction to antibiotics, the aged or those with impaired hepatic function in the absence of close monitoring, making it important to carefully balance potential risks with expected benefits in primary care. Pharmacogenetic testing using the new genome-wide association studies approach holds promise for better understanding the mechanism(s) underlying hepatotoxicity.

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“…Cefprozil has been reported to have no significant change in PK parameters in patients with liver function problems compared to normal control subjects. Therefore, it does not require dose adjustment [10]. However, in patients with renal impairment, cefprozil has significant changes in PK parameters such as decreased clearance and increased half-life, compared to normal control subjects.…”

Section: Introductionmentioning

confidence: 99%

Population Pharmacokinetics of Cis-, Trans-, and Total Cefprozil in Healthy Male Koreans

et al. 2019

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Cefprozil, one of cephalosporin antibiotics, has been used extensively in clinics. However, pharmacokinetic (PK) information on cefprozil is still very limited. There have been no reports of population pharmacokinetics (PPKs). A PPK model for cefprozil will be a great advantage for clinical use. Thus, the aim of this study was to develop a PPK model for cefprozil for healthy male Koreans. Clinical PK and demographic data of healthy Korean males receiving cefprozil at a dose of 1000 mg were analyzed using Phoenix® NLME™. A one-compartment model with first-order absorption with lag-time was constructed as a base model. The model was extended to include covariates that influenced between-subject variability. Creatinine clearance significantly influenced systemic clearance of cefprozil. The final PPK model for cis-, trans-, and total cefprozil was established and validated. PPK parameter values of cis- and total cefprozil were similar to each other, but different from those of trans-isomer. Herein, we describe the establishment of accurate PPK models of cis-, trans-, and total cefprozil for healthy male Koreans for the first time. It may be useful as a dosing algorithm for the general population. These results might also contribute to the development of stereoisomeric cefprozil.

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A rare case of hepatitis associated with cefprozil therapy

Cited by 14 publications

References 15 publications

Cefdinir-Induced Hepatotoxicity: Potential Hazards of Inappropriate Antibiotic Use

Cefdinir-Induced Hepatotoxicity: Potential Hazards of Inappropriate Antibiotic Use

Hepatic safety of antibiotics used in primary care

Population Pharmacokinetics of Cis-, Trans-, and Total Cefprozil in Healthy Male Koreans

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