Probable Sulbactam/Ampicillin-Associated Prolonged Cholestasis

[Guest guest]

Published online, 19 October 2004, www.theannals.com, DOI 10.1345/aph.1E225.

The ls of Pharmacotherapy: Vol. 38, No. 12, pp. 2055-2058. DOI

10.1345/aph.1E225

© 2004 Harvey Whitney Books Company.

Probable Sulbactam/Ampicillin-Associated Prolonged Cholestasis

Seyfettin Köklü, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital,

Ankara, Turkey

Aydin Köksal, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital

Mehmet Asil, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital

Halil Kiyici, MD

Specialist, Department of Pathology, Bakent University, Konya Research and

Practice Hospital, Konya, Turkey

ahin Çoban, MD

Research Fellow, Department of Gastroenterology, Ankara University Medical

School, Ankara

Mehmet Arhan, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital

Reprints: Seyfettin Köklü MD, Tip Fakültesi caddesi, 259 / 3, Mamak, Ankara,

Turkey, fax 90-312-3124120, gskoklu@...

OBJECTIVE: To present a single case of sulbactam/ampicillin-induced chronic

cholestasis and a literature review of antibiotic-associated chronic

cholestasis.

CASE SUMMARY: 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.

DISCUSSION: 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.

Key Words: antibiotics, cholestasis, drug-related liver injury,

hepatotoxicity, sulbactam/ampicillin

Published online, October 19, 2004. www.theannals.com, DOI 10.1345/aph.1E225

[Guest guest]

Published online, 19 October 2004, www.theannals.com, DOI 10.1345/aph.1E225.

The ls of Pharmacotherapy: Vol. 38, No. 12, pp. 2055-2058. DOI

10.1345/aph.1E225

© 2004 Harvey Whitney Books Company.

Probable Sulbactam/Ampicillin-Associated Prolonged Cholestasis

Seyfettin Köklü, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital,

Ankara, Turkey

Aydin Köksal, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital

Mehmet Asil, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital

Halil Kiyici, MD

Specialist, Department of Pathology, Bakent University, Konya Research and

Practice Hospital, Konya, Turkey

ahin Çoban, MD

Research Fellow, Department of Gastroenterology, Ankara University Medical

School, Ankara

Mehmet Arhan, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital

Reprints: Seyfettin Köklü MD, Tip Fakültesi caddesi, 259 / 3, Mamak, Ankara,

Turkey, fax 90-312-3124120, gskoklu@...

OBJECTIVE: To present a single case of sulbactam/ampicillin-induced chronic

cholestasis and a literature review of antibiotic-associated chronic

cholestasis.

CASE SUMMARY: 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.

DISCUSSION: 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.

Key Words: antibiotics, cholestasis, drug-related liver injury,

hepatotoxicity, sulbactam/ampicillin

Published online, October 19, 2004. www.theannals.com, DOI 10.1345/aph.1E225

[Guest guest]

Published online, 19 October 2004, www.theannals.com, DOI 10.1345/aph.1E225.

The ls of Pharmacotherapy: Vol. 38, No. 12, pp. 2055-2058. DOI

10.1345/aph.1E225

© 2004 Harvey Whitney Books Company.

Probable Sulbactam/Ampicillin-Associated Prolonged Cholestasis

Seyfettin Köklü, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital,

Ankara, Turkey

Aydin Köksal, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital

Mehmet Asil, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital

Halil Kiyici, MD

Specialist, Department of Pathology, Bakent University, Konya Research and

Practice Hospital, Konya, Turkey

ahin Çoban, MD

Research Fellow, Department of Gastroenterology, Ankara University Medical

School, Ankara

Mehmet Arhan, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital

Reprints: Seyfettin Köklü MD, Tip Fakültesi caddesi, 259 / 3, Mamak, Ankara,

Turkey, fax 90-312-3124120, gskoklu@...

OBJECTIVE: To present a single case of sulbactam/ampicillin-induced chronic

cholestasis and a literature review of antibiotic-associated chronic

cholestasis.

CASE SUMMARY: 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.

DISCUSSION: 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.

Key Words: antibiotics, cholestasis, drug-related liver injury,

hepatotoxicity, sulbactam/ampicillin

Published online, October 19, 2004. www.theannals.com, DOI 10.1345/aph.1E225

[Guest guest]

Published online, 19 October 2004, www.theannals.com, DOI 10.1345/aph.1E225.

The ls of Pharmacotherapy: Vol. 38, No. 12, pp. 2055-2058. DOI

10.1345/aph.1E225

© 2004 Harvey Whitney Books Company.

Probable Sulbactam/Ampicillin-Associated Prolonged Cholestasis

Seyfettin Köklü, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital,

Ankara, Turkey

Aydin Köksal, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital

Mehmet Asil, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital

Halil Kiyici, MD

Specialist, Department of Pathology, Bakent University, Konya Research and

Practice Hospital, Konya, Turkey

ahin Çoban, MD

Research Fellow, Department of Gastroenterology, Ankara University Medical

School, Ankara

Mehmet Arhan, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek htisas Hospital

Reprints: Seyfettin Köklü MD, Tip Fakültesi caddesi, 259 / 3, Mamak, Ankara,

Turkey, fax 90-312-3124120, gskoklu@...

OBJECTIVE: To present a single case of sulbactam/ampicillin-induced chronic

cholestasis and a literature review of antibiotic-associated chronic

cholestasis.

CASE SUMMARY: 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.

DISCUSSION: 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.

Key Words: antibiotics, cholestasis, drug-related liver injury,

hepatotoxicity, sulbactam/ampicillin

Published online, October 19, 2004. www.theannals.com, DOI 10.1345/aph.1E225