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Hepatitis associated with amoxycillin-clavulanic acid combination report of 15 cases

D Larrey1, T Vial, A Micaleff

  • 1Service des Maladies de l'Appareil Digestif, Hôpital Saint-Eloi, Montpellier, France.

Gut
|March 1, 1992
PubMed

Insights

Hepatitis linked to amoxicillin-clavulanic acid is rare, affecting mostly older men. Symptoms appear weeks after treatment, but recovery is typical within months, suggesting a low overall risk.

Area of Science:

  • Hepatology
  • Clinical Pharmacology
  • Drug-Induced Liver Injury

Background:

  • Amoxicillin-clavulanic acid is a widely used antibiotic combination.
  • Drug-induced liver injury (DILI) is a significant concern in clinical practice.
  • Hepatitis associated with antibiotic use requires careful monitoring and characterization.

Purpose of the Study:

  • To report and characterize cases of hepatitis associated with amoxicillin-clavulanic acid.
  • To investigate the clinical presentation, laboratory findings, and outcomes of this specific drug-induced hepatitis.
  • To estimate the incidence and identify potential risk factors for amoxicillin-clavulanic acid-induced hepatitis.

Main Methods:

  • Retrospective case series analysis of fifteen patients diagnosed with hepatitis.
  • Review of clinical data, including patient demographics, treatment details, symptoms, laboratory results (liver enzymes), and liver histology.
  • Estimation of the incidence of hepatitis based on reported cases and estimated drug usage.

Main Results:

  • Fifteen cases of hepatitis were identified, predominantly in men over 60 years old.
  • Hepatitis symptoms, including jaundice and pruritus, often appeared 1-4 weeks after treatment cessation.
  • Elevated aminotransferases and alkaline phosphatase were consistent findings; liver histology showed cholestasis. Recovery was generally complete within 4-16 weeks.
  • The estimated risk of hepatitis was very low (below 1/100,000), but potentially higher in elderly men with prolonged treatment.

Conclusions:

  • Amoxicillin-clavulanic acid can cause hepatitis, characterized by cholestasis and a generally good prognosis.
  • Elderly men receiving prolonged treatment may be at increased risk.
  • The findings suggest a possible immunoallergic mechanism in some cases of drug-induced hepatitis.

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