AN UNUSUAL CASE OF AMOXICILLIN-CLAVULANIC ACID-RELATED HEPATOTOXICITY

Amoxicillin/clavulanic acid is a widely used antibiotic. Hepatic dysfu nction is a rare adverse reaction associated with this combination ant ibiotic. We report the case of a 40-yr-old woman with a somewhat unusu al presentation of amoxicillin/clavulanate-related cholestatic hepatot oxicity and multiple duodenal erosions whose diagnosis was delayed unt il inadvertent rechallenge,vith the antibiotic combination. The releva nt literature is also reviewed and discussed. The diagnosis may be mis sed because the onset of signs/symptoms may occur several weeks after the cessation of therapy. The hepatic dysfunction, which may be severe and is more prevalent in elderly patients, is usually reversible, alt hough chronic liver disease and deaths have been reported. Immunologic al hypersensitivity is considered to be the most likely mechanism resu lting in liver injury, Amoxicillin/ clavulanate should be used with ca ution in patients with underlying liver disease and in the elderly. (A m J Gastroenterol 1998;93:1363-1365. (C) 1998 by Am. Cell. of Gastroen terology).