{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T11:31:11Z","timestamp":1771327871370,"version":"3.50.1"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Amoxycillin\/clavulanic acid is the most common antimicrobial cause of drug-induced liver injury in adults. It is a less common cause of severe drug-related hepatotoxicity in children despite its frequent use. We studied the incidence, characteristics and predictive factors for amoxycillin\/clavulanic acid hepatoxicity in children.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Retrospective cohort study of children who received oral or intravenous amoxycillin\/clavulanic acid at a quaternary children\u2019s hospital over a 5-year period. Children were included if they had liver function tests (LFTs) determined at baseline, during and within 3\u2005months after the treatment course. Causality was assessed using the Naranjo criteria for adverse drug reactions and Roussel Uclaf Causality Assessment Method.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 3271 children prescribed amoxycillin\/clavulanic acid, 374 were included. Forty-nine (13%) had LFT abnormalities related to amoxycillin\/clavulanic acid. Fourteen (3.6%) fulfilled Common Terminology Criteria for Adverse Events (CTCAE) grade 2 criteria with clinically significant hepatotoxicity. Age &amp;lt;2\u2005years, sepsis, post-gastrointestinal surgical indications, prolonged treatment course of &amp;gt;7\u2005days and higher cumulative amoxycillin (&amp;gt;10\u2005g) and clavulanic acid dose (&amp;gt;1\u2005g) were predictive of hepatotoxicity. The median time to resolution of LFT abnormalities was 4\u2005weeks (range 3\u20137).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The incidence of amoxycillin\/clavulanic acid related LFT abnormalities (CTCAE Grade 2 or above) in children was 3.6%. A prolonged treatment course &amp;gt;7\u2005days, high cumulative amoxycillin (10\u2005g) and clavulanic acid (&amp;gt;1\u2005g) doses, those aged &amp;lt;2\u2005years, and patients with sepsis or post-gastrointestinal surgery were predictive of a higher likelihood of abnormal LFTs. LFT monitoring should be considered in children receiving \u22657\u2005days of treatment, particularly in those with other predisposing factors.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkae009","type":"journal-article","created":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T07:11:58Z","timestamp":1706771518000},"page":"589-594","source":"Crossref","is-referenced-by-count":3,"title":["Incidence of amoxycillin-clavulanic acid associated hepatotoxicity in an Australian children\u2019s hospital"],"prefix":"10.1093","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3615-2187","authenticated-orcid":false,"given":"Jessica A","family":"Eldredge","sequence":"first","affiliation":[{"name":"Department of General Medicine, The Royal Children\u2019s Hospital Melbourne , 50 Flemington Road, Parkville, Victoria 3052 , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2395-4574","authenticated-orcid":false,"given":"Laure F","family":"Pittet","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Faculty of Medicine, Infectious Diseases Unit, Gynaecology and Obstetrics, University of Geneva and University Hospitals of Geneva , Geneva , Switzerland"},{"name":"Murdoch Children\u2019s Research Institute, Royal Children\u2019s Hospital Melbourne , 50 Flemington Road, Parkville, Victoria 3052 , Australia"},{"name":"Department of Paediatrics, University of Melbourne, Royal Children's Hospital Melbourne , Reception Level 2, West Building, 50 Flemington Road , Parkville, Victoria 3052, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4016-8986","authenticated-orcid":false,"given":"Amanda","family":"Gwee","sequence":"additional","affiliation":[{"name":"Department of General Medicine, The Royal Children\u2019s Hospital Melbourne , 50 Flemington Road, Parkville, Victoria 3052 , Australia"},{"name":"Murdoch Children\u2019s Research Institute, Royal Children\u2019s Hospital Melbourne , 50 Flemington Road, Parkville, Victoria 3052 , Australia"},{"name":"Department of Paediatrics, University of Melbourne, Royal Children's Hospital Melbourne , Reception Level 2, West Building, 50 Flemington Road , Parkville, Victoria 3052, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"2024030105180934900_dkae009-B1","doi-asserted-by":"crossref","first-page":"e185","DOI":"10.1097\/INF.0000000000000719","article-title":"Australia-wide point prevalence survey of antimicrobial prescribing in neonatal units: how much and how good?","volume":"34","author":"Osowicki","year":"2015","journal-title":"Pediatr Infect Dis 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