Possible roxithromycin-induced fulminant hepatic failure in a child

A pediatric formulation of roxithromycin is a relatively new addition to th e antibiotic market in Australia. A previously healthy 5-year-old boy with no significant medical history was treated with roxithromycin 50 mg twice/d ay for cough, fever, and anorexia. After completing a 5-day course of the a gent, he developed a nonpruritic, nonurticarial, erythematous, maculopapula r, generalized rash and occasional vomiting. Three days later his symptoms included jaundice, dark urine, and pale stools. Laboratory results revealed acute hepatitis, and the patient was admitted to the hospital. His hepatic function continued to deteriorate, so the boy was transferred to a tertiar y pediatric hospital. His condition continued to worsen, and 6 days after t ransfer, he underwent liver transplantation. Clinicians should be aware of potential hepatic complications associated with the use of roxithromycin.