[Cholestatic jaundice after ingestion of amoxicillin and clavulanic acid]

A 61-year-old woman fell ill with recurrent nausea, loss of appetite and tiredness. Five days later she noted increasing jaundice of skin and sclerae, pale stools and dark urine, and she developed itching over the whole body. Among biochemical tests alkaline phosphatase (537 U/l) and bilirubin (32.0 mg/dl) were markedly increased, while both GOT (102 U/l) and GPT (39 U/l) were only slightly elevated. Ultrasonography was normal and extrahepatic cholestasis appeared unlikely on endoscopic retrograde cholangiopancreatography. Cholestasis due to virus hepatitis was also excluded. It was only on repeated and direct questioning that the patient reported having taken three tablets daily of Augmentin (amoxicillin and clavulanic acid) for 12 days 5 weeks before the onset of symptoms.

After symptomatic treatment with Colestyramine (4 g three times daily), ursodeoxycholic acid (250 mg twice daily) and the antihistaminic Clemastine (1 g two times daily) the severe pruritus decreased quickly and alkaline phosphatase concentration became normal. At follow-up examination 4 and 8 weeks later the laboratory tests were normal.

This report of Augmentin-induced cholestasis is not unique. It shows that previous drug intake must be carefully investigated in any case of cholestasis of unknown cause.