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Probable sulbactam/ampicillin-associated prolonged cholestasis.
Seyfettin Köklü1, Aydin S Köksal, Mehmet Asil
1Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. gskoklu@yahoo.com
The Annals of Pharmacotherapy
|October 21, 2004
Summary
Sulbactam/ampicillin, a common antibiotic, may cause chronic cholestatic hepatitis. This case highlights a rare adverse effect, emphasizing the need for clinical awareness during liver injury diagnosis.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Infectious Diseases
Background:
- Antibiotic-associated liver injury is a recognized clinical concern.
- Chronic cholestasis is a less common manifestation of drug-induced liver injury.
- Sulbactam/ampicillin is a widely prescribed antibiotic combination.
Observation:
- A 74-year-old man with Hodgkin's disease developed prolonged cholestasis after a 7-day course of sulbactam/ampicillin.
- Other potential causes of cholestasis were excluded.
- The patient recovered fully 7 months after discontinuing the antibiotic.
Findings:
- This case represents the first reported instance of chronic cholestasis attributed to sulbactam/ampicillin.
- The Naranjo probability scale indicated a probable link between sulbactam/ampicillin and the cholestasis.
- While ampicillin alone has been linked to hepatic injury, cholestasis from the combination was previously unreported.
Implications:
- Sulbactam/ampicillin should be considered as a potential cause of chronic cholestatic hepatitis.
- Clinicians must maintain a high index of suspicion for this adverse effect in patients presenting with liver injury.
- Awareness of this potential side effect is crucial for accurate diagnosis and patient management.