en
Scientific article
English

Incidence of amoxycillin-clavulanic acid associated hepatotoxicity in an Australian children's hospital

Published inThe Journal of antimicrobial chemotherapy, vol. 79, no. 3, p. 589-594
Publication date2024-01-31
First online date2024-01-31
Abstract

Objectives: Amoxycillin/clavulanic acid is the most common antimicrobial cause of drug-induced liver injury in adults. It is a less common cause of severe drug-related hepatotoxicity in children despite its frequent use. We studied the incidence, characteristics and predictive factors for amoxycillin/clavulanic acid hepatoxicity in children.

Design: Retrospective cohort study of children who received oral or intravenous amoxycillin/clavulanic acid at a quaternary children's hospital over a 5-year period. Children were included if they had liver function tests (LFTs) determined at baseline, during and within 3 months after the treatment course. Causality was assessed using the Naranjo criteria for adverse drug reactions and Roussel Uclaf Causality Assessment Method.

Results: Of 3271 children prescribed amoxycillin/clavulanic acid, 374 were included. Forty-nine (13%) had LFT abnormalities related to amoxycillin/clavulanic acid. Fourteen (3.6%) fulfilled Common Terminology Criteria for Adverse Events (CTCAE) grade 2 criteria with clinically significant hepatotoxicity. Age <2 years, sepsis, post-gastrointestinal surgical indications, prolonged treatment course of >7 days and higher cumulative amoxycillin (>10 g) and clavulanic acid dose (>1 g) were predictive of hepatotoxicity. The median time to resolution of LFT abnormalities was 4 weeks (range 3-7).

Conclusions: The incidence of amoxycillin/clavulanic acid related LFT abnormalities (CTCAE Grade 2 or above) in children was 3.6%. A prolonged treatment course >7 days, high cumulative amoxycillin (10 g) and clavulanic acid (>1 g) doses, those aged <2 years, and patients with sepsis or post-gastrointestinal surgery were predictive of a higher likelihood of abnormal LFTs. LFT monitoring should be considered in children receiving ≥7 days of treatment, particularly in those with other predisposing factors.

eng
Citation (ISO format)
ELDREDGE, Jessica A, PITTET, Laure, GWEE, Amanda. Incidence of amoxycillin-clavulanic acid associated hepatotoxicity in an Australian children’s hospital. In: The Journal of antimicrobial chemotherapy, 2024, vol. 79, n° 3, p. 589–594. doi: 10.1093/jac/dkae009
Main files (1)
Article (Published version)
accessLevelRestricted
Identifiers
ISSN of the journal0305-7453
9views
0downloads

Technical informations

Creation02/28/2024 3:19:39 PM
First validation04/30/2024 8:14:04 AM
Update time04/30/2024 8:14:04 AM
Status update04/30/2024 8:14:04 AM
Last indexation05/06/2024 6:29:20 PM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack