Hepatotoxicity of Antimicrobial Agents

Brown, Steven J; Desmond, Paul

doi:10.1055/s-2002-30103

Cited by 54 publications

(26 citation statements)

References 84 publications

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“…The development of hepatitis 4-6 weeks after drug ingestion in both cases is consistent with prior reports of B-lactam associated hepatotoxicity (2,3). Neither patient had prominent features of a hypersensitivity reaction such as fever and eosinophilia that has been reported in up to 50% of patients with amoxicillin/clavulanate hepatotoxicity (4,5). However, review of available liver histology demonstrated histological features compatible with a severe drug induced hepatitis in both cases (Figure 1).…”

Section: Discussionsupporting

confidence: 88%

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Acute Liver Failure Due To Amoxicillin and Amoxicillin/Clavulanate

et al. 2005

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The aim of our study is to report upon the presentation of two patients with life-threatening acute liver failure (ALF) due to amoxicillin and amoxicillin/clavulanate. A 59-year-old, Caucasian male presented with ALF 34 days after receiving amoxicillin/clavulanate. Despite aggressive supportive care, he died on hospital day 10. A 42-year-old, Caucasian female presented with ALF 21 days after receiving amoxicillin. She underwent successful liver transplantation on hospital day 19. In both cases, all competing causes of ALF had been excluded, liver pathology was consistent with drug-induced hepatitis, and cases were deemed "definite/highly probable" using causality assessment. Amongst 14 prior ALF/death cases due to amoxicillin/clavulanate, the mean age (62 years), male predominance (57%), and mean delay from drug cessation to presentation (17 days) is similar to what has been reported in patients with self-limited cholestatic hepatitis. Acute liver failure is a rare manifestation of amoxicillin and amoxicillin/clavulanate hepatotoxicity with no obvious clinical features at presentation portending a poor prognosis. Early transfer of patients with severe drug-induced hepatotoxicity (i.e., encephalopathy or coagulopathy) to a transplant center is recommended due to their poor likelihood of recovery.

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Section: Discussionsupporting

confidence: 88%

“…A delayed cholestatic or mixed hepatocellular-cholestatic liver injury pattern has typically been reported with amoxicillin/clavulanate that usually has a benign course and resolves within 2 months (2)(3)(4)(5).…”

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confidence: 99%

Acute Liver Failure Due To Amoxicillin and Amoxicillin/Clavulanate

et al. 2005

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“…14,18 The combination of Cefixime+Clavulanic acid have caused increased liver enzymes in 7 patients, our finding well supported by previous studies showing Semisynthetic penicillins are frequent causes of hepatotoxicity, especially when combined with clavulanic acid. 19 Interstitial nephritis was also found in our study in patients consuming β-Lactam antibiotics (Amoxycillin). The findings of this study were in accordance with recent studies showing β-Lactam antibiotics causing Interstitial nephritis.…”

Section: Discussionsupporting

confidence: 78%

A prospective study on prevalence of adverse drug reactions due to antibiotics usage in otolaryngology department of a tertiary care hospital in North India

Khan

Nizamuddin

Huda

et al. 2013

Int J Basic Clin Pharmacol

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Background: Polypharmacy, advancing age and longer duration of hospital stay are the factors responsible for adverse drug reactions (ADRs). This study has attempted to analyze the pattern of antimicrobial prescription in OPD & IPD of the Otolaryngology department and to detect, document, assess and report the suspected ADRs due to antibiotic use and preparation of guidelines to minimize the incidence of ADRs. Methods: A prospective study conducted at the TMMC&RC on patients aged >40 years, who visited the Otolaryngology department over a period of 5 months. Suspected ADRs were assessed for causality and severity using Naranjo’s probability scale and modified Hartwig’s criteria, respectively. Results: Out of 1200, 925 prescriptions were analyzed. Most patients were from 41-60 age (59.45%) followed by 61-80 age (37.29%) and least from >80 yr (3.24%). But the incidence of ADRs were found to be higher in patients of >80 yr age group n=8 (26.66%). The most commonly prescribed antibacterials were β-Lactams (64.61%). Out of 925 prescriptions studied, only 94 were found to have 154 ADRs. The most commonly identified ADRs were Gastrointestinal 47.40%, followed by Neurotoxicity 24.67%, cutaneous reactions 20.12%, Hepatic 4.54% and Kidney 3.24%. 74.67% of the ADRs were probable and 20.77% were possible type and only 4.54% were definite. 74.67% ADRs were found to be type A, and 25.32% type B. Conclusions: Our study showed that prevalence of ADRs was highest in elder age group and diarrhea was the most common ADR found. Therefore elderly patients should be given special attention when prescribing medications to avoid clinically significant harmful consequences. Minimizing unnecessary antibiotic use by even a small percentage could signiﬁcantly reduce the immediate and direct risks of drug-related adverse events in individual patients. [Int J Basic Clin Pharmacol 2013; 2(5.000): 548-553

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“…Although this is true for some drugs (e.g., estrogens induce cholestatic injury and seldom any present with any other pattern of damage), for most other drugs such consistency is not so clear. For instance, amoxicillin-clavulanate tends to produce cholestatic or mixed damage, although hepatocellular damage has been repor ted frequently as well [16,54] . Hepatocellular and cholestatic or mixed injury have been noted with nimesulide [55] or troglitazone [56,57] , among others.…”

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confidence: 99%

Assessment of drug-induced hepatotoxicity in clinical practice: A challenge for gastroenterologists

Andrade¹,

Robles²,

Fernández-Castañer³

et al. 2007

WJG

142

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Currently, pharmaceutical preparations are serious contributors to liver disease; hepatotoxicity ranking as the most frequent cause for acute liver failure and postcommercialization regulatory decisions. The diagnosis of hepatotoxicity remains a difficult task because of the lack of reliable markers for use in general clinical practice. To incriminate any given drug in an episode of liver dysfunction is a step-by-step process that requires a high degree of suspicion, compatible chronology, awareness of the drug's hepatotoxic potential, the exclusion of alternative causes of liver damage and the ability to detect the presence of subtle data that favors a toxic etiology. This process is time-consuming and the final result is frequently inaccurate. Diagnostic algorithms may add consistency to the diagnostic process by translating the suspicion into a quantitative score. Such scales are useful since they provide a framework that emphasizes the features that merit attention in cases of suspected hepatic adverse reaction as well. Current efforts in collecting bona fide cases of drug-induced hepatotoxicity will make refinements of existing scales feasible. It is now relatively easy to accommodate relevant data within the scoring system and to delete low-impact items. Efforts should also be directed toward the development of an abridged instrument for use in evaluating suspected drug-induced hepatotoxicity at the very beginning of the diagnosis and treatment process when clinical decisions need to be made. The instrument chosen would enable a confident diagnosis to be made on admission of the patient and treatment to be finetuned as further information is collected.

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Hepatotoxicity of Antimicrobial Agents

Cited by 54 publications

References 84 publications

Acute Liver Failure Due To Amoxicillin and Amoxicillin/Clavulanate

Acute Liver Failure Due To Amoxicillin and Amoxicillin/Clavulanate

A prospective study on prevalence of adverse drug reactions due to antibiotics usage in otolaryngology department of a tertiary care hospital in North India

Assessment of drug-induced hepatotoxicity in clinical practice: A challenge for gastroenterologists

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