Monika Studniarz, Piotr Czubkowski, Joanna Cielecka-Kuszyk, Irena Jankowska, Mikołaj Teisseyre, Diana Kamińska, Małgorzata Markiewicz, Dorota Broniszczak, Joanna Pawłowska Ann Transplant 2012; 17(1): 128-131 DOI: 10.12659/AOT.882646 Background: Amoxicillin/clavulanic acid-induced liver injury is a well recognized complication. Presentation and outcome may vary, which is related to individual liver maturity, genetic predisposition, enzyme heterogeneity, intensity of treatment, and drug interactions. In most cases withdrawing the drug is sufficient treatment; however, cases of progressive liver damage leading to liver transplantation have been reported. Case Report: We present the case of an 8-year-old patient after liver transplantation who developed drug induced liver injury (DILI) after amoxicillin/clavulanic acid treatment for upper respiratory tract infection. Jaundice appeared 2 days after cessation of treatment. Clinical presentation and liver biopsy were consistent with DILI. Because of rapidly increasing bilirubin levels, we used 3 boluses of methylprednisolone and ursodeoxycholic acid. Amoxicillin is used in the treatment of a number of infections, including acute otitis media, streptococcal pharyngitis, pneumonia, skin infections, urinary tract infections, Salmonella infections, Lyme disease, and chlamydia infections. Children with acute otitis media who are younger than 6 months of age are generally treated with amoxicillin or other antibiotic. Although most children with acute otitis media who are older than two years old do not benefit from treatment with amoxicillin or other antibiotic, such treatment may be helpful in children younger than two years old with acute otitis media that is bilateral or accompanied by ear drainage. In the past, amoxicillin was dosed three times daily when used to treat acute otitis media, which resulted in missed doses in routine ambulatory practice. There is now evidence that two times daily dosing or once daily dosing has similar effectiveness. Amoxicillin is recommended as the preferred first-line treatment for community-acquired pneumonia in adults by the National Institute for Health and Care Excellence, either alone (mild to moderate severity disease) or in combination with a macrolide. It is effective as one part of a multi-drug regimen for treatment of stomach infections of Helicobacter pylori.
Augmentin (amoxicillin/clavulanic acid) is the best illustration of the commercial success achievable by developing a combination of a β-lactam antibiotic with a class A β-lactamase inhibitor.144From: to amoxicillin clavulanic acid (co-amoxiclav) are usually assumed to be caused by the amoxicillin, although there have been reports of allergic reactions to clavulanic acid (SEDA-30, 287). Allergy to clavulanic acid has been reported in 10 children aged 4–12 years . The diagnosis was based on the confirmation of an Ig E-mediated etiology by a positive oral challenge test with clavulanic acid and negative tests, including skin tests with amoxicillin, ampicillin, penicillins G and V, and cefaclor. Allergic contact dermatitis has also been attributed to clavulanic acid The combination of amoxicillin clavulanic acid (co-amoxiclav) has been marketed in several formulations. In Europe, it is available in ratios of 2:1, 4:1, and 7:1; in the USA, a 14:1 ratio has been approved (). The onset liver damage due to co-amoxiclav generally occurs at several days to weeks after starting therapy. A combination of advanced age and long-term therapy (more than 10 days) increases the risk (). Amoxicillin—clavulanic acid combination— associated hepatitis and jaundice was first identified in 1988. Numerous case reports and case series have been published since then, but there is no precise estimate of this risk. A retrospective cohort study in the United Kingdom to estimate the risk of acute liver injury associated with the combination of amoxicillin and clavulanic acid and compare it with the one of amoxicillin alone. Data were derived from a cohort of 93 433 users of the combination drug amoxicillin—clavulanic acid and 360 333 users of amoxicillin alone who were aged between 10 and 79 years and who were followed up from 1991 through 1992. After reviewing the information on subjects with suspected liver injury that was recorded on computer files, the clinical records of 177 patients from the attending general practitioners were requested. They were 35 cases of idiopathic acute liver injury. There were 14 cases of acute liver injury among users of amoxicillin alone. The type of liver injury was hepatocellular in half the cases.
Amoxicillin-clavulanate is currently the most common cause of clinically apparent, drug induced acute liver injury both in the United States and Europe. Feb 11, 2019. Amoxicillin/clavulanate Augmentin is an antibiotic commonly used to treat infections of the sinuses, throat, and lung airways bronchitis. Liver.