हेपेटोलॉजी और गैस्ट्रोइंटेस्टाइनल विकारों के जर्नल
खुला एक्सेस

अमूर्त

एमोक्सिसिलिन बनाम एमोक्सिसिलिन/क्लैवुलैनेट के कारण लिवर की क्षति: इटली में दवा-प्रेरित लिवर की क्षति केस-कंट्रोल अध्ययन का उपसमूह विश्लेषण

मोनिया डोनाटी, डोमेनिको मोटोला, रॉबर्टो लियोन, उगो मोरेटी, जियोवाना स्टॉपा, ऐलेना अर्जेंटन, मारिया कार्मेला लेंटी, रॉबर्टो बोनाईयूटी, एलेसेंड्रो मुगेली, अल्फ्रेडो वन्नासी, कॉन्सेटा रफानिएलो, लिबरेटा स्पोर्टिएलो, एनालिसा कैपुआनो, ऑस्कर बोर्टोलामी और अल्बर्टो वाचेरी

Objective: Several studies showed that amoxicillin plus clavulanic acid (co-amoxiclav) is one of the most common agents associated to serious Drug Induced Liver Injury (DILI). We estimated the risk of acute serious DILI associated with amoxicillin alone compared with co-amoxiclav, through a multicenter case-control study carried out in nine Italian hospitals from October 2010 to January 2014.

Methods: Cases were adults, with a diagnosis of acute liver injury. Controls presented acute clinical disorders, not related to chronic conditions and not involving the liver. Adjusted Odds Ratio (ORs) with 95% CI were calculated initially with a bivariate and then multivariate analysis.

Results: We analysed 179 cases matched to 1770 controls. Seven cases were exposed to amoxicillin (adjusted OR 1.69, 95% CI 0.72-3.98) and 22 cases to co-amoxiclav (adjusted OR 3.00, 95% CI 1.76-5.40).

Conclusions: Co-amoxiclav almost doubled the risk of serious acute liver injury compared to amoxicillin alone. The incidence of co-amoxiclav induced DILI is very low but the widespread use of this drug by the general population makes the risk clinically relevant. The often inappropriate prescription of antimicrobial agents, and in particular of co-amoxiclav, could expose a given patient to a life-threatening risk compared to a negligible clinical benefit.