Amoxicillin-clavulanic acid-induced hepatitis

Objectives: The aim of this study was to report a rare side effect of amoxicillin-clavulanic acid resulting in drug-induced hepatitis in the treatment of chronic rhinosinusitis. Methods: This is a case report and literature review of amoxicillin-clavulanic acid-induced hepatitis in the treatment of chronic rhinosinusitis. A MEDLINE search of the published literature from 1966 to 2006 was performed using the term amoxicillin-clavulanic acid + hepatitis. Results: We report a case of a 53-year-old man who developed drug-induced hepatitis after the use of amoxicillin-clavulanic acid for the treatment of chronic rhinosinusitis. After a 4-week course of amoxicillin-clavulanic acid, the patient developed pruritus and jaundice. Liver function tests revealed elevated aminotransferase levels. Serologic examination result for hepatitis A, B, and C was negative. The amoxicillin-clavulanic acid was discontinued and the patient was treated conservatively. The pruritus and jaundice gradually resolved and the patient had no long-term complications. The literature review revealed this is the first reported case of amoxicillin-clavulanic acid-induced hepatitis for the treatment of chronic rhinosinusitis. Conclusions: Drug-induced hepatitis is a rare side effect of amoxicillin-clavulanic acid. Care must be taken in prescribing this drug to elderly patients and patients with liver disease. In general, the hepatitis is mild to moderate, rarely leads to liver failure, and can be managed conservatively. (C) 2007 Elsevier Inc. All rights reserved.