Cholestatic hepatitis flucloxacillin

If a patient has cholestasis careful consideration must be given to the use of any drug that can cause biliary problems. Several drugs are known to cause cholestatic hepatitis, including the antibiotics flucloxacillin, erythromycin and co-amoxiclav (amoxicillin/clavulanic acid). Although a patient with cholestasis is no more likely to suffer from this idiosyncratic reaction than a patient without liver impairment, it will be of greater concern if it does occur. 

Prolonged duration of treatment and increasing age were risk factors for flucloxacillin-induced jaundice (181), and cholestatic liver injury has been described most often with flucloxacUhn (182,183) and other isoxazolylpenicillins (184). Whether cholestatic hepatitis after the combination of amoxicUhn with clavulanic acid (co-amoxiclav) is related to one of these categories is not yet clear. 

Devereaux BM, Crawford DH, Purcell P, Powell LW, Roeser HP. Flucloxacillin associated cholestatic hepatitis. An Australian and Swedish epidemic Eur J Clin Pharmacol 1995 49(l-2) 81-5. 

Liver The risk of flucloxacillin-assodated cholestatic liver disease has been assessed in a study of 346 072 first-time users of flucloxacillin, of whom 21 developed cholestatic hepatitis within 1-45 days after a prescription the incidence estimate was 6.1 per 100 000 users (95% Cl = 3.8, 9.3) [103 ]. In comparison, there were four cases out of 1 179 360 first-time users of penicillin V, an incidence estimate of 0.3 per 100 000 users (95% Cl = 0.1, 0.9). 

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