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Published Online, 19 October 2004, www.theannals.com, DOI 10.1345/aph.1E225.
 The Annals of Pharmacotherapy: Vol. 38, No. 12, pp. 2055-2058. DOI 10.1345/aph.1E225
© 2004 Harvey Whitney Books Company.
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Probable Sulbactam/Ampicillin–Associated Prolonged Cholestasis

Seyfettin Köklü, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey

Aydin S Köksal, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital

Mehmet Asil, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital

Halil Kiyici, MD

Specialist, Department of Pathology, Baskent University, Konya Research and Practice Hospital, Konya, Turkey

Sahin Çoban, MD

Research Fellow, Department of Gastroenterology, Ankara University Medical School, Ankara

Mehmet Arhan, MD

Specialist, Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital

Reprints: Seyfettin Köklü MD, Tip Fakültesi caddesi, 259 / 3, Mamak, Ankara, Turkey, fax 90-312-3124120, gskoklu{at}yahoo.com

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




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