O-37 AMOXICILLIN-CLAVULANATE INDUCED LIVER INJURY: TEN YEARS EXPERIENCE FROM LATINDILI REGISTRY.
Introduction and Objectives: Although amoxicillin-clavulanate combination (ACC) is a well-established cause of liver injury, clinicians are unaware of some aspects that explain why its diagnosis may be initially missed, making the patient susceptible to unnecessary exploration or treatment. This stu...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-03-01
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| Series: | Annals of Hepatology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268123001485 |
| _version_ | 1827981894099140608 |
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| author | Nelia Hernandez Fernando Bessone Daniela Chiodi Manuel Mendizabal A Sanchez Ezequiel Ridruejo Carla Bianchi Carmen Pollio Marco Arrese María Isabel Schinoni Vinicius Nunes Raymundo Paraná Edgardo Mengual Maribel Lizárzabal Inmaculada Medina-Caliz Mercedes Robles-Díaz Aida Ortega-Alonso Raúl Andrade María Isabel Lucena |
| author_facet | Nelia Hernandez Fernando Bessone Daniela Chiodi Manuel Mendizabal A Sanchez Ezequiel Ridruejo Carla Bianchi Carmen Pollio Marco Arrese María Isabel Schinoni Vinicius Nunes Raymundo Paraná Edgardo Mengual Maribel Lizárzabal Inmaculada Medina-Caliz Mercedes Robles-Díaz Aida Ortega-Alonso Raúl Andrade María Isabel Lucena |
| author_sort | Nelia Hernandez |
| collection | DOAJ |
| description | Introduction and Objectives: Although amoxicillin-clavulanate combination (ACC) is a well-established cause of liver injury, clinicians are unaware of some aspects that explain why its diagnosis may be initially missed, making the patient susceptible to unnecessary exploration or treatment. This study aimed to describe DILI characteristics linked to ACC in the LATINDILI registry. Materials and Methods: We revised data concerning DILI-ACC in the LATINDILI registry during the last decade, looking for information on latency, pattern, severity, and evolution. Baseline characteristics were described using mean, median, and percentages; Student's t-test or a chi-squared test was used to determine the difference between mean and frequencies. A P-value of less than 0.05 was considered statistical significance. Results: We identified 61 DILI-ACC episodes in 60 patients from the LATINDILI registry. The mean age was 58 years (19-90 y), and 54% were male. Median latency was 21 days, with median ALT and ALP at DILI onset of 282 U/L (range 34-2130) and 585 U/L (range 96-1626), respectively; a cholestatic/mixed pattern predominated in 43 cases. In 53 cases, the liver injury appeared with a mean of 13 days (range 2-39 d) after treatment ended. Twenty patients (33%) had allergic immune features, 79% were jaundiced, and 61% required hospitalization. The mean total bilirubin values increased by 7.5 mg/dl (1.5-16) from the onset in 24 of 42 evaluable patients after ten days (range 2-30). Table 1 shows the comparison between groups. Resolution of liver injury occurred on average 64 (14-270) days, one patient did not normalize after 365 days, and no death was consigned. Conclusions: Jaundice linked to a cholestatic/mixed pattern appearing after stopping therapy was a frequent presentation of ACC in our analysis. This clinical presentation may be missed when using ACC and explaining the delayed diagnosis. Worsening bilirubin value is frequent and may be related to longer treatment duration and prolonged latency. |
| first_indexed | 2024-04-09T22:15:02Z |
| format | Article |
| id | doaj.art-608efa7c7ea44266b74830b001be983b |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-04-09T22:15:02Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-608efa7c7ea44266b74830b001be983b2023-03-23T04:34:43ZengElsevierAnnals of Hepatology1665-26812023-03-0128101044O-37 AMOXICILLIN-CLAVULANATE INDUCED LIVER INJURY: TEN YEARS EXPERIENCE FROM LATINDILI REGISTRY.Nelia Hernandez0Fernando Bessone1Daniela Chiodi2Manuel Mendizabal3A Sanchez4Ezequiel Ridruejo5Carla Bianchi6Carmen Pollio7Marco Arrese8María Isabel Schinoni9Vinicius Nunes10Raymundo Paraná11Edgardo Mengual12Maribel Lizárzabal13Inmaculada Medina-Caliz14Mercedes Robles-Díaz15Aida Ortega-Alonso16Raúl Andrade17María Isabel Lucena18Gastroenterology Clinic, Hospital de Clínicas, Republic University, Montevideo, UruguayGastroenterology Service, Centenary Hospital, National University of Rosario, Rosario, ArgentinaGastroenterology Clinic, Hospital de Clínicas, Republic University, Montevideo, UruguayLiver and Liver Transplant Unit, Austral, Austral University Hospital, Pilar, ArgentinaGastroenterology Clinic, Hospital de Clínicas, Republic University, Montevideo, UruguayHepatology Section, Department of Medicine, Center for Medical Education and Clinical Research Norberto Quirno ''CEMIC'', Buenos Aires, ArgentinaMautone Sanatorium, Maldonado, UruguayDepartment of Gastroenterology, Maciel Hospital, Montevideo, UruguayDepartment of Gastroenterology, School of Medicine. Pontifical Catholic University of Chile, Santiago, ChileInstitute of Health Science and University Hospital, Federal University of Bahia, Bahia, BrazilDepartment of Clinical Medicine and Gastroenterology, Federal University of Bahia, Bahia, BrazilDepartment of Clinical Medicine and Gastroenterology, Federal University of Bahia, Bahia, BrazilGastrointestinal Research Laboratory, Institute of Biological Research. School of Medicine. University of Zulia. Maracaibo, VenezuelaDepartment of Gastroenterology, School of Medicine, Zulia University. Maracaibo, VenezuelaDepartment of Gastroenterology, School of Medicine, Zulia University. Maracaibo, VenezuelaDepartment of Gastroenterology, School of Medicine, Zulia University. Maracaibo, VenezuelaDepartment of Gastroenterology, School of Medicine, Zulia University. Maracaibo, VenezuelaDepartment of Gastroenterology, School of Medicine, Zulia University. Maracaibo, VenezuelaDigestive System CMU, Clinical Pharmacology Service, Institute of Biomedical Research Institute of Malaga and Nanomedicine Platform-IBIMA. BIONAND Platform, Virgen de la Victoria University Hospital, University of Malaga, CIBERehd. Malaga, SpainIntroduction and Objectives: Although amoxicillin-clavulanate combination (ACC) is a well-established cause of liver injury, clinicians are unaware of some aspects that explain why its diagnosis may be initially missed, making the patient susceptible to unnecessary exploration or treatment. This study aimed to describe DILI characteristics linked to ACC in the LATINDILI registry. Materials and Methods: We revised data concerning DILI-ACC in the LATINDILI registry during the last decade, looking for information on latency, pattern, severity, and evolution. Baseline characteristics were described using mean, median, and percentages; Student's t-test or a chi-squared test was used to determine the difference between mean and frequencies. A P-value of less than 0.05 was considered statistical significance. Results: We identified 61 DILI-ACC episodes in 60 patients from the LATINDILI registry. The mean age was 58 years (19-90 y), and 54% were male. Median latency was 21 days, with median ALT and ALP at DILI onset of 282 U/L (range 34-2130) and 585 U/L (range 96-1626), respectively; a cholestatic/mixed pattern predominated in 43 cases. In 53 cases, the liver injury appeared with a mean of 13 days (range 2-39 d) after treatment ended. Twenty patients (33%) had allergic immune features, 79% were jaundiced, and 61% required hospitalization. The mean total bilirubin values increased by 7.5 mg/dl (1.5-16) from the onset in 24 of 42 evaluable patients after ten days (range 2-30). Table 1 shows the comparison between groups. Resolution of liver injury occurred on average 64 (14-270) days, one patient did not normalize after 365 days, and no death was consigned. Conclusions: Jaundice linked to a cholestatic/mixed pattern appearing after stopping therapy was a frequent presentation of ACC in our analysis. This clinical presentation may be missed when using ACC and explaining the delayed diagnosis. Worsening bilirubin value is frequent and may be related to longer treatment duration and prolonged latency.http://www.sciencedirect.com/science/article/pii/S1665268123001485 |
| spellingShingle | Nelia Hernandez Fernando Bessone Daniela Chiodi Manuel Mendizabal A Sanchez Ezequiel Ridruejo Carla Bianchi Carmen Pollio Marco Arrese María Isabel Schinoni Vinicius Nunes Raymundo Paraná Edgardo Mengual Maribel Lizárzabal Inmaculada Medina-Caliz Mercedes Robles-Díaz Aida Ortega-Alonso Raúl Andrade María Isabel Lucena O-37 AMOXICILLIN-CLAVULANATE INDUCED LIVER INJURY: TEN YEARS EXPERIENCE FROM LATINDILI REGISTRY. Annals of Hepatology |
| title | O-37 AMOXICILLIN-CLAVULANATE INDUCED LIVER INJURY: TEN YEARS EXPERIENCE FROM LATINDILI REGISTRY. |
| title_full | O-37 AMOXICILLIN-CLAVULANATE INDUCED LIVER INJURY: TEN YEARS EXPERIENCE FROM LATINDILI REGISTRY. |
| title_fullStr | O-37 AMOXICILLIN-CLAVULANATE INDUCED LIVER INJURY: TEN YEARS EXPERIENCE FROM LATINDILI REGISTRY. |
| title_full_unstemmed | O-37 AMOXICILLIN-CLAVULANATE INDUCED LIVER INJURY: TEN YEARS EXPERIENCE FROM LATINDILI REGISTRY. |
| title_short | O-37 AMOXICILLIN-CLAVULANATE INDUCED LIVER INJURY: TEN YEARS EXPERIENCE FROM LATINDILI REGISTRY. |
| title_sort | o 37 amoxicillin clavulanate induced liver injury ten years experience from latindili registry |
| url | http://www.sciencedirect.com/science/article/pii/S1665268123001485 |
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