Augmentin-induced jaundice with a fatal outcome.
OBJECTIVE
To report a case of death due to Augmentin-induced cholestatic hepatitis and discuss a possible drug interaction between Augmentin and oestrogenic steroids.
An 81-year-old man, on oestrogen therapy for prostatic malignancy, presented with obstructive jaundice one week after completing a four-week course of Augmentin for recurrent urinary tract infection. Liver biopsy showed features of a drug-induced cholestatic hepatitis with bile duct injury. His clinical course was marked by progressive deterioration with increasing jaundice and the development of hepatic encephalopathy. A course of prednisolone did not result in any improvement and he died nine weeks after the onset of jaundice.


CONCLUSIONS
The cholestatic hepatitis induced by Augmentin is usually reversible but may be progressive, leading to death. The concurrent administration of ethinyloestradiol, a potentially cholestatic agent, may have altered the susceptibility and/or course of the reaction in this patient.
Hebbard
G S
GS
Department of Gastroenterology, Royal Melbourne Hospital, VIC.
Smith
K G
KG
Gibson
P R
PR
Bhathal
P S
PS
D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000009:adverse effects; D019980:Amoxicillin-Potassium Clavulanate Combination; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D002779:Cholestasis / Q000139:chemically induced*; D002969:Clavulanic Acids / Q000009:adverse effects; D004347:Drug Interactions; D045166:Estradiol Congeners / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000188:drug therapy; D014552:Urinary Tract Infections / Q000188:drug therapy
D002969:Clavulanic Acids; D045166:Estradiol Congeners; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin