Related Experiment Video

Updated: Oct 6, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Cholangiopathy after short-term administration of piperacillin and imipenem/cilastatin

C Quattropani1, M Schneider, A Helbling

  • 1Departments of Clinical Pharmacology,Visceral and Transplantation Surgery,Clinical Immunology and Pathology, University of Berne, Switzerland.

Liver
|June 26, 2001
PubMed

Insights

Antibiotic-induced liver injury can occur with short-term use of piperacillin and imipenem/cilastatin. This case highlights potential immunological mechanisms and the need for careful monitoring of liver function during antibiotic therapy.

Area of Science:

  • Hepatology
  • Pharmacology
  • Immunology

Background:

  • Abdominal trauma and intestinal perforation necessitate perioperative antibiotic treatment.
  • Piperacillin and imipenem/cilastatin are commonly used antibiotics for intra-abdominal infections.

Observation:

  • A patient developed jaundice, fatigue, and pruritus two weeks post-discharge after a 3-day course of piperacillin and imipenem/cilastatin.
  • Liver biopsy revealed centrizonal bilirubinostasis, eosinophilic portal infiltrate, and cholangitis.

Findings:

  • Lymphocyte transformation tests were positive for both piperacillin and imipenem/cilastatin, indicating an immune-mediated drug reaction.
  • The patient experienced cholestasis and elevated liver enzymes, consistent with drug-induced liver injury (DILI).

Implications:

  • Short-term antibiotic therapy with piperacillin/imipenem-cilastatin can cause hepatotoxicity, similar to other beta-lactam antibiotics.
  • Positive lymphocyte transformation tests and liver biopsy findings support an immunological mechanism for this DILI.
  • Prompt diagnosis and cessation of the offending agent are crucial for full clinical and biochemical recovery from antibiotic-induced liver injury.

Related Concept Videos

Cholecystitis01:20

Cholecystitis

Cholecystitis is inflammation of the gallbladder, most commonly caused by obstruction of the cystic duct. This blockage prevents bile from draining, leading to gallbladder distension, inflammation, and potentially serious complications. This condition may present acutely or chronically and can happen with or without gallstones.EtiologyAbout 95% of cholecystitis cases are calculous, caused by gallstones blocking the cystic duct, leading to bile accumulation and inflammation of the gallbladder...
Acute Pancreatitis I: Introduction01:25

Acute Pancreatitis I: Introduction

Acute pancreatitis is the sudden inflammation of the pancreas caused by the early activation of digestive enzymes, leading to the autodigestion of pancreatic tissue. This results in local inflammation and, in severe cases, systemic complications.EtiologyUnderstanding the underlying causes is crucial, as identifying the etiology guides treatment and anticipates complications. Acute pancreatitis can be triggered by various factors, typically grouped into the following clinical categories.Biliary...
Chronic Pancreatitis II: Pathophysiology01:21

Chronic Pancreatitis II: Pathophysiology

Chronic pancreatitis is a progressive and irreversible inflammation of the pancreas, most often caused by long-term alcohol abuse, but it can also be related to ductal obstruction, smoking, or genetic factors.Chronic pancreatitis occurs when the pancreas is repeatedly exposed to harmful agents like alcohol, smoking, ductal obstruction, or genetic predisposition. These factors lead to the release of toxic metabolites and inflammatory cytokines, sustaining chronic inflammation in the pancreatic...
Chronic Pancreatitis II: Collaborative Care01:29

Chronic Pancreatitis II: Collaborative Care

The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
Assessment:
Acute Pancreatitis II: Pathophysiology01:21

Acute Pancreatitis II: Pathophysiology

The pathophysiology of acute pancreatitis centers on injury to pancreatic acinar cells, which initiates a cascade of harmful intracellular events.This injury leads to premature activation of trypsinogen to trypsin in the pancreas. Trypsin then activates other digestive enzymes, such as chymotrypsin, elastase, and phospholipase A2, which begin breaking down pancreatic tissue. The resulting autodigestion causes local inflammation, tissue swelling, hemorrhage, and fat necrosis.Injured acinar cells...
Chronic Bowel Disorders: Introduction01:17

Chronic Bowel Disorders: Introduction

Chronic bowel diseases are a group of long-term conditions affecting the digestive tract, characterized by inflammation and damage to the gut lining. These conditions primarily include irritable bowel syndrome and inflammatory bowel disease.
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...