药物警戒杂志

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Amoxicillin /Clavulanic Acid Induced Mixed Hepatocellular-Cholestatic Hepatic Injury- A Rare Case Report

Shreshth Khanna, Vandana Tayal, Vandana Roy

Amoxicillin is an extended spectrum acid stable bactericidal beta-lactam antibiotic, commonly used in the treatment and prophylaxis of gram positive and negative bacterial infections. Clavulanic acid, a beta-lactamase inhibitor that is often used in conjunction with amoxicillin (co-amoxiclav) prevents the hydrolysis and re-establishes amoxicillin's activity that binds irreversibly to the catalytic site of susceptible beta-lactamases and has good activity against beta-lactamase producing streptococci, staphylococci, Klebsiella pneumonia, H. influenzae and penicillinase-producing anaerobes and is most commonly used for upper respiratory infections, otitis media and sinusitis to broaden its spectrum further and combat resistance. Commonly reported adverse effects of co-amoxiclav include nausea, vomiting, headache, abdominal pain, skin rashes and oral thrush. Few rare and serious adverse drug reactions associated with its use include anaphylaxis, angioedema, hemolytic anemia, drug rash with eosinophilia and systemic symptoms (DRESS Syndrome), multi-organ dysfunctions, seizures and hepatobiliary injury.