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Severe hepatitis associated with oxacillin therapy.

Hossam Al-Homaidhi1, Nahed M Abdel-Haq, Mohammad El-Baba

  • 1Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.

Southern Medical Journal
|June 26, 2002
PubMed
Summary

Oxacillin can cause severe liver injury (hepatotoxicity) in children, characterized by high liver enzymes and prolonged clotting times. Symptoms resolved after switching to cefazolin, suggesting oxacillin-induced liver damage.

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Area of Science:

  • Pediatric Pharmacology
  • Hepatology
  • Infectious Diseases

Background:

  • Staphylococcal osteomyelitis is a serious bone infection often requiring prolonged antibiotic treatment.
  • Oxacillin is a commonly prescribed beta-lactam antibiotic for staphylococcal infections.
  • Drug-induced liver injury (DILI) is a significant concern in pediatric patients undergoing extended antibiotic regimens.

Observation:

  • A 6-year-old girl developed acute, anicteric hepatitis with elevated liver enzymes, prolonged prothrombin time, leukopenia, and eosinophilia during intravenous oxacillin therapy.
  • The patient's clinical presentation and laboratory abnormalities were consistent with drug-induced liver injury.
  • Cessation of oxacillin and substitution with cefazolin led to rapid clinical improvement and normalization of liver function tests.

Findings:

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  • Oxacillin therapy was associated with severe hepatotoxicity in a pediatric patient.
  • The observed liver injury appeared to be specific to oxacillin, as other beta-lactam antibiotics (cefazolin) were not implicated.
  • Key laboratory findings included marked elevation of liver enzymes, prolonged prothrombin time, leukopenia, and eosinophilia.

Implications:

  • Healthcare providers should consider monitoring liver function tests in pediatric patients receiving prolonged oxacillin treatment.
  • This case highlights the potential for oxacillin-specific hepatotoxicity, necessitating careful patient monitoring.
  • Early recognition and discontinuation of the offending agent are crucial for managing drug-induced liver injury in children.