Probable sulbactam/ampicillin-associated prolonged cholestasis.
OBJECTIVE
To present a single case of sulbactam/ampicillin-induced chronic cholestasis and a literature review of antibiotic-associated chronic cholestasis.


METHODS
A 74-year-old man with Hodgkin's disease in remission developed severe and prolonged cholestasis after treatment with sulbactam/ampicillin 750 mg twice daily for 7 days. All other etiologies, including Hodgkin's disease, were appropriately ruled out and the cholestasis was ascribed to sulbactam/ampicillin treatment. The patient improved gradually and became asymptomatic 7 months after the last dose of sulbactam/ampicillin. According to the Naranjo probability scale, sulbactam/ampicillin was the probable cause of the cholestasis.


CONCLUSIONS
Ampicillin, a semisynthetic penicillin, has rarely been associated with hepatic injury when used alone. Hepatocellular and acute cholestatic injury due to ampicillin have been described. Cholestasis secondary to sulbactam/ampicillin use has not been previously reported.


CONCLUSIONS
Sulbactam/ampicillin, one of the most widely used antibiotics, may cause chronic cholestatic hepatitis. Clinicians should be aware of this adverse affect and consider it during diagnostic workup of liver injury.
Köklü
Seyfettin
S
Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. gskoklu@yahoo.com
Köksal
Aydin S
AS
Asil
Mehmet
M
Kiyici
Halil
H
Coban
Sahin
S
Arhan
Mehmet
M
D000368:Aged; D000667:Ampicillin / Q000008:administration & dosage / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002779:Cholestasis / Q000139:chemically induced*; D002908:Chronic Disease; D004338:Drug Combinations; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D013407:Sulbactam / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D004791:Enzyme Inhibitors; D000667:Ampicillin; D013407:Sulbactam