Antibacterials
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Hepatotoxicity and cross-reactivity: case report A 3.5-month-old boy developed hepatotoxicity following treatment with ertapenem, ceftriaxone, amoxicillin/clavulanic acid and ciprofloxacin. Additionally, hepatotoxicity consistently occurred after the use of ertapenem, ceftriaxone and amoxicillin/clavulanic acid, conferring cross-sensitivity to antibacterial drugs of the β-lactam group [not all durations of treatments to reactions onsets stated]. The boy was admitted in the uroandrology department of the Russian Children’s Clinical Hospital (RCCH) at the age of 3.5 months due to changes in urine analysis (presence of protein, erythrocytes and leukocytes in the urine) and bacteraemia caused by Staphylococcus epidermidis. His medical history was significant for hypertension, metabolic acidosis, anaemia, delayed physical and mental development and a combined malformation of the genitourinary system (a biscuit-like kidney; cross-dystopia of the left kidney, ureterocele and megaureter of the lower segment on the right, diphallia, recurrent pyelonephritis and stage 4–5 chronic kidney disease). He had undergone a number of reconstructive surgeries, including the removal of the perineal second penis, as well as stenting of two of the three ureters. On admission, he received IV ertapenem 25mg twice a day. However, by the end of the third week of drug use, laboratory signs of hepatotoxicity were noted. Additionally, spleen enlargement was seen. Ertapenem was discontinued as changes in urine persisted. At that time, Stenotrophomonas maltophilia was isolated in the urine, which was found to be sensitive to cotrimoxazole. As a result, he received cotrimoxazole. After a week of cotrimoxazole use, urine analysis improved significantly and the level of transaminases spontaneously returned to normal. After a short period of relative well-being, exacerbation of pyelonephritis was noted. Consequently, he received IV ceftriaxone 250mg once a day. However, the duration of ceftriaxone use was short (4 days) due to a sharp increase in the level of transaminases. Subsequently, the levels of transaminases normalised without the addition of hepatoprotective drugs. Thereafter, he received meropenem, followed by piperacillin/ tazobactam with a significant improvement in urine abnormalities and without any signs of hepatotoxicity. He was discharged from the hospital after 1.5 months. During his stay at home, he developed a new exacerbation of pyelonephritis. After admission, he received amoxicillin/clavulanic acid (amoxicillin 250mg and clavulanic acid 62.5mg) 40 mg/kg suspension twice a day. During the treatment, the transaminases levels were found to be increased without enlargement of spleen or liver. Considering these indicators as a manifestation of drug hepatotoxicity, amoxicillin/clavulanic acid was stopped. He received amoxicillin/clavulanic acid for a total of 10 days. The urine abnormalities persisted and urine examination revealed the presence of Pseudomonas aeruginosae. Consequently, he received IV ciprofloxacin 30mg twice a da
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