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Cefdinir
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Reactions 1238 - 7 Feb 2009 ★ S Cefdinir Liver injury (first report) in a morbidly obese patient: case report A 22-year-old morbidly obese man developed drug-induced liver injury (DILI) while receiving cefdinir for presumed streptococcal pharyngitis. The man received a 10-day course of oral cefdinir 300mg twice daily, and presented 5 days later with a history of painless jaundice and pruritus since treatment completion. Examination disclosed morbid obesity, jaundice and scleral icterus, and laboratory investigations showed the following levels: total bilirubin 15.7 mg/dL, conjugated bilirubin 12.5 mg/dL, ALT 96 IU/L, AST 66 IU/L, ALP 175 IU/L and GGT 77 IU/L; his INR was normal. Viral and metabolic liver diseases were excluded. On hospital day 5, a liver biopsy revealed moderate cholestasis with lobular and portal mixed inflammation and focal bile duct injury; findings were compatible with DILI. The man received symptomatic therapy with colestyramine and hydroxyzine, but his pruritus persisted. Three weeks after presentation, his INR increased to 1.5, and his total and conjugated bilirubin levels reached maxima at 41.4 mg/dL and 25.1 mg/dL, respectively; his AST and ALT levels had decreased. A short prednisone taper was initiated and all his symptoms had resolved within 7 weeks of admission; his bilirubin levels normalised, but his ALP and GGT levels remained mildly elevated. Author comment: "The close temporal relationship between the start of the cefdinir and the onset of the symptoms, and the lack of any other potentially hepatotoxic drugs, combined with the biopsy findings and lack of biliary dilation on imaging, strongly suggest that cefdinir caused the development of hepatotoxicity in this patient. . . The reasons for [the prolonged course] are unclear but may have been related to his morbid obesity, and hence possible metabolic syndrome." Chen J, et al. Cefdinir-induced hepatotoxicity: potential hazards of inappropriate antibiotic use. Journal of General Internal Medicine 23: 1914-1916, No. 11, Nov 2008 - USA 801135351 » Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of liver injury associated with cefdinir. The WHO Adverse Drug Reactions database contained no reports of liver injury [MedDRA] associated with cefdinir. 1 Reactions 7 Feb 2009 No. 1238 0114-9954/10/1238-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Cefdinir
Reactions 1238 - 7 Feb 2009
★ SCefdinir
Liver injury (first report) in a morbidly obesepatient: case report
A 22-year-old morbidly obese man developed drug-inducedliver injury (DILI) while receiving cefdinir for presumedstreptococcal pharyngitis.
The man received a 10-day course of oral cefdinir 300mgtwice daily, and presented 5 days later with a history ofpainless jaundice and pruritus since treatment completion.Examination disclosed morbid obesity, jaundice and scleralicterus, and laboratory investigations showed the followinglevels: total bilirubin 15.7 mg/dL, conjugated bilirubin12.5 mg/dL, ALT 96 IU/L, AST 66 IU/L, ALP 175 IU/L and GGT77 IU/L; his INR was normal. Viral and metabolic liver diseaseswere excluded. On hospital day 5, a liver biopsy revealedmoderate cholestasis with lobular and portal mixedinflammation and focal bile duct injury; findings werecompatible with DILI.
The man received symptomatic therapy with colestyramineand hydroxyzine, but his pruritus persisted. Three weeks afterpresentation, his INR increased to 1.5, and his total andconjugated bilirubin levels reached maxima at 41.4 mg/dL and25.1 mg/dL, respectively; his AST and ALT levels haddecreased. A short prednisone taper was initiated and all hissymptoms had resolved within 7 weeks of admission; hisbilirubin levels normalised, but his ALP and GGT levelsremained mildly elevated.
Author comment: "The close temporal relationshipbetween the start of the cefdinir and the onset of thesymptoms, and the lack of any other potentially hepatotoxicdrugs, combined with the biopsy findings and lack of biliarydilation on imaging, strongly suggest that cefdinir caused thedevelopment of hepatotoxicity in this patient. . . The reasonsfor [the prolonged course] are unclear but may have beenrelated to his morbid obesity, and hence possible metabolicsyndrome."Chen J, et al. Cefdinir-induced hepatotoxicity: potential hazards of inappropriateantibiotic use. Journal of General Internal Medicine 23: 1914-1916, No. 11, Nov2008 - USA 801135351
» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of liver injuryassociated with cefdinir. The WHO Adverse Drug Reactionsdatabase contained no reports of liver injury [MedDRA]associated with cefdinir.
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Reactions 7 Feb 2009 No. 12380114-9954/10/1238-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
