A 3-year-old child with acute otitis media presents with fever (39.2°C), HR 120/min, and otalgia. Cultures identify penicillin-resistant Streptococcus pneumoniae. He is prescribed amoxicillin-clavulanate. On day 14 of therapy, he develops jaundice and pruritus. Laboratory studies show ALT 340 U/L, AST 380 U/L, and elevated bilirubin. Abdominal ultrasound shows no gallstones. He denies diarrhea. Which antimicrobial component most likely caused this hepatotoxicity?
- A)Accumulation of clavulanic acid in hepatocytes due to immature renal function
- B)Clavulanic acid-associated hepatotoxicity, manifesting as cholestatic injuryGABARITO
- C)Bacterial superinfection of the liver by penicillin-resistant S. pneumoniae
- D)Amoxicillin allergy with immune-mediated hepatitis
- E)Drug-induced fatty liver disease from amoxicillin metabolism
Explicação
Clavulanic acid, a beta-lactamase inhibitor, causes cholestatic hepatotoxicity (elevated alkaline phosphatase and bilirubin with relatively mild transaminitis) with an incidence of 1-3 cases per 10,000 exposures. Risk increases with treatment duration >14 days... Ver explicação completa e trilha adaptativa →