Hepatotoxic reactions induced by beta-lactamase inhibitors.
Since amoxicillin/clavulanate was first introduced in the UK in 1981, beta-lactamase inhibitors are used increasingly worldwide. Two more drugs of this class are currently available, sulbactam and tazobactam. Meanwhile, adverse drug reactions associated with amoxicillin/clavulanate occurring late after the end of therapy have been repeatedly published. In many cases, a cholestatic hepatitis was diagnosed that was most likely caused by the clavulanic acid component of the combination. Symptoms were mostly mild and reversible, whereas a number of cases showing a protracted, even fatal course of the disease have been documented. This article summarizes and analyzes all relevant studies and case reports dealing with hepatotoxicity caused by beta-lactamase inhibitors. The description of a typical case from our own patient population illustrates the clinical challenge associated with this adverse drug reaction.
Berg
P
P
Department of Medicine I, Friedrich-Alexander-University of Erlangen-Nuremberg, D-91054 Erlangen-Nuremberg, Germany. Peter.Berg@med1.imed.uni-erlangen.de
Hahn
E G
EG
D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D004791:Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000201:enzymology; D008560:Membrane Fluidity; D008875:Middle Aged; D000254:Sodium-Potassium-Exchanging ATPase / Q000378:metabolism; D065093:beta-Lactamase Inhibitors
D004791:Enzyme Inhibitors; D065093:beta-Lactamase Inhibitors; D000254:Sodium-Potassium-Exchanging ATPase