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阿莫西林-克拉维酸钾为广泛应用的抗生素,其抗菌谱同阿莫西林。已有阿莫西林-克拉维酸钾引起肝炎和胆汁淤积型黄疸的报道,其机制尚不十分清楚,可能和免疫反应与代谢因素有关。其发生率约为0.001%～0.022%,肝毒性反应一般发生在用药后数天至数周(平均8.9d)。临床表现为黄疸、瘙痒、疲劳、恶心、呕吐、肝大、皮疹、腹痛和发热等。血清ALT、AST、碱性磷酸酶、γ-谷氨酰转肽酶水平明显升高(正常值上限的2～10倍)。一般停药后1～8周黄疸消退,4～16周肝功能恢复正常。肝毒性反应的危险因素包括男性(男:女之比约为4:1至2:1),老年,用药时间长及合并用药(尤其是肝毒性药物如对乙酰氨基酚、别嘌醇、红霉素等)。预防措施为:严格掌握适应证,大于65岁男性老年患者不用或慎用,用药时间一般不超过14d,避免多药合用,用药过程中加强监测。
Amoxicillin - potassium clavulanate is a widely used antibiotic whose antibacterial spectrum is the same as amoxicillin. Amoxicillin-clavulanate potassium has been reported to cause hepatitis and cholestatic jaundice. The mechanism is not yet clear, and may be related to immune response and metabolic factors. The incidence of about 0.001% to 0.022%, liver toxicity usually occurs in a few days to several weeks after treatment (average 8.9d). Clinical manifestations of jaundice, itching, fatigue, nausea, vomiting, hepatomegaly, rash, abdominal pain and fever. Serum ALT, AST, alkaline phosphatase, γ-glutamyl transpeptidase levels were significantly elevated (2 to 10 times the upper limit of normal). General withdrawal 1 to 8 weeks after the jaundice subsided, 4 to 16 weeks liver function returned to normal. Risk factors for hepatotoxicity include males (male to female ratio of about 4: 1 to 2: 1), old age, long duration of medication and combination therapy (especially hepatotoxic drugs such as acetaminophen, allopurinol, Etc.). Preventive measures: strict indications, older than 65-year-old male needless or caution, medication time is generally not more than 14d, to avoid multi-drug combination, to strengthen the monitoring process.