Adverse Effects of Methicillin, Nafcillin and Oxacillin in
Pediatric Patients

Nahata, Milap C.; DeBolt, Sherry L.; Powell, Dwight A.

doi:10.1159/000457400

Cited by 15 publications

(6 citation statements)

References 13 publications

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“…In a larger study of 119 patients treated with the antibiotic, 8.1% of patients developed liver function abnormalities [1]. Nahata and co-workers described transaminitis occurring in one of 32 patients treated with nafcillin [3]. Table 2 lists reported cases of hepatocellular injury induced by various antibiotics and Table 3 [4-7] lists the reported cases of nafcillin-induced hepatocellular disease.…”

Section: Discussionmentioning

confidence: 99%

Nafcillin-Induced Allergic Eosinophilic Cholestatic Hepatitis

et al. 2017

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A 71-year-old female with no history of liver disease or antibiotic allergy developed jaundice with elevated liver enzymes and eosinophilia following treatment with nafcillin for septic arthritis. Further workup demonstrated hepatocellular dysfunction and liver biopsy showed expansion of portal tracts by lymphocytes and eosinophils consistent with a hypersensitivity reaction. Nafcillin and related antibiotics were withdrawn, and her symptoms resolved 3 months later. We searched PubMed using terms of “nafcillin cholestasis” and “nafcillin hepatitis”, and a review of the literature showed other reports of nafcillin-induced hepatitis and cholestasis. Avoidance and on occasion the guarded use of glucocorticoids can lead to recovery from the insult. This case report shows that while rare, nafcillin can cause cholestatic hepatitis through a likely eosinophil-mediated hypersensitivity reaction. Further studies are needed to elucidate the mechanism of this reaction.

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Section: Discussionmentioning

confidence: 99%

Nafcillin-Induced Allergic Eosinophilic Cholestatic Hepatitis

et al. 2017

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“…A single-centre prospective study (Nahata 37 ) compared children who received IV methicillin, nafcillin or oxacillin in an inpatient setting and found an incidence of DILI of 0% (0/28), 3.1% (1/32) and 12.5% (1/8), respectively. High IV doses were used with mean doses of 106 mg/kg/day (SD ± 31.2) for methicillin, 118 mg/kg/day (SD ± 33.9) for nafcillin and 153 mg/kg/day (SD ± 24.6) for oxacillin.…”

Section: Resultsmentioning

confidence: 99%

“…Two prospective studies of IV methicillin found an overall incidence of DILI of 14/103 (13.6%). 37 , 39 In both studies, children had LFTs performed weekly.…”

Section: Resultsmentioning

confidence: 99%

“…In addition to the prospective study by Nahata 37 previously mentioned, a randomized controlled trial (Kitzing 39 ) of 149 children aged 0 to 13 years compared the frequency of DILI in children with soft tissue, and bone and joint infections who received either IV methicillin 200 mg/kg/day or IV nafcillin 150 mg/kg/day. The incidence of DILI was comparable between the methicillin group (14/75, 18.7%) and the nafcillin group (12/74, 16.2%) (χ² = 0.155, P = 0.69).…”

Section: Resultsmentioning

confidence: 99%

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Frequency of drug-induced liver injury in children receiving anti-staphylococcal penicillins

Tang

Coombs

Gwee

2022

Journal of Antimicrobial Chemotherapy

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Introduction Anti-staphylococcal penicillins (ASPs) are among the most commonly prescribed antibiotics in children and are associated with a risk of drug-induced liver injury (DILI). Despite the frequent use of ASPs in children, there is no consensus on whether liver function tests (LFTs) should be routinely monitored during treatment. Objectives To review the literature on the frequency of ASP-related DILI in children to determine the incidence, risk factors and outcomes of hepatotoxicity. Methods PubMed, MEDLINE and Embase were searched in January 2022 for original studies of children who received cloxacillin, dicloxacillin, flucloxacillin, methicillin, nafcillin or oxacillin that included ≥10 children aged up to 18 years, and presented data on the incidence of DILI in children exposed to ASPs. Results Overall, two studies of oral flucloxacillin, two of intravenous (IV) methicillin, three of IV nafcillin and four of IV oxacillin were included. The mean onset of DILI ranged between 7.0 and 19.0 days following commencement of antibiotic treatment and all episodes resolved between 14.2 and 16.0 days after drug discontinuation, with no specific treatment required. This review found that the incidence of DILI in children was 1 in 50 000 for oral flucloxacillin and ranged from 1 in 3 to 13 for IV oxacillin, methicillin and nafcillin. Conclusions This review found that routine LFT monitoring is not required in children receiving low dose oral flucloxacillin in a primary care setting, although pharmacovigilance is critical. For IV preparations, the existing data support routine LFT monitoring in those receiving treatment for at least 7 days.

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“…Nahata et al. reviewed the ADRs of nafcillin, methicillin and oxacillin in 68 paediatric patients 4 . Elevated liver enzyme, neutropenia and eosinophilia were the major adverse reactions in the oxacillin treatment group.…”

Section: Discussionmentioning

confidence: 99%

Reversible oxacillin‐associated hepatitis in a 9‐month‐old boy

Lee

Chen

Huang

et al. 2008

J Paediatrics Child Health

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Herein we present a case of a 9-month-old boy admitted to our hospital for acute femoral osteomyelitis and hip septic arthritis treatment. Acute hepatitis with concomitant skin rash developed on the sixth day of intravenous oxacillin therapy. No other known virus- or drug-related skin eruption or hepatitis was suspected. The boy recovered completely after antibiotics were shifted to teicoplanin, and no sequelae were noted. To our knowledge, this boy is the youngest case of reported oxacillin-related hepatitis in the literatures.

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Adverse Effects of Methicillin, Nafcillin and Oxacillin in Pediatric Patients

Cited by 15 publications

References 13 publications

Nafcillin-Induced Allergic Eosinophilic Cholestatic Hepatitis

Nafcillin-Induced Allergic Eosinophilic Cholestatic Hepatitis

Frequency of drug-induced liver injury in children receiving anti-staphylococcal penicillins

Reversible oxacillin‐associated hepatitis in a 9‐month‐old boy

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