title: Liver damage from flucloxacillin, cloxacillin and dicloxacillin.
abstract: We describe a case of severe cholestatic liver disease, which persisted for 7 years, and was probably induced by flucloxacillin. We also report a survey of 77 liver reactions which were probably or possibly induced by penicillinase-resistant penicillins and spontaneously reported to the Swedish Adverse Drug Reactions Advisory Committee. The reactions were usually cholestatic with a tendency to a protracted course. There is some evidence for an immunoallergic idiosyncratic reaction. The incidence of reported liver reactions was estimated from sales data to be 1.6-2.9 per million DDD (defined daily doses) or, for flucloxacillin 1:11,000-1:30,000 prescriptions. Female sex, age and high daily doses seemed to be associated with higher risk of liver reactions from flucloxacillin.
authors.affiliation: Department of Medicine II, University of Gothenburg, Sweden.
authors.forename: R
authors.initials: R
authors.lastname: Olsson
authors.forename: B E
authors.initials: BE
authors.lastname: Wiholm
authors.forename: C
authors.initials: C
authors.lastname: Sand
authors.forename: L
authors.initials: L
authors.lastname: Zettergren
authors.forename: R
authors.initials: R
authors.lastname: Hultcrantz
authors.forename: M
authors.initials: M
authors.lastname: Myrhed
mesh_terms: D056486:Chemical and Drug Induced Liver Injury; D002779:Cholestasis / Q000139:chemically induced / Q000453:epidemiology / Q000473:pathology; D003023:Cloxacillin / Q000009:adverse effects*; D004009:Dicloxacillin / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005436:Floxacillin / Q000009:adverse effects*; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D008875:Middle Aged; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D005436:Floxacillin; D004009:Dicloxacillin; D003023:Cloxacillin