{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:33:39Z","timestamp":1791405219511,"version":"4.3.3"},"reference-count":26,"publisher":"BMJ","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"accepted":{"date-parts":[[2000,5,9]]},"published-print":{"date-parts":[[2000,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND AND AIMS<\/jats:title>\n                    <jats:p>Jaundice associated with co-amoxiclav has been increasingly recognised. We aimed to characterise its clinical and histological features and to investigate linkage with human leucocyte antigen class II haplotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We identified cases in the west of Scotland in the period 1991\u20131997 and performed polymerase chain reaction amplification and oligonucleotide probing on whole blood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Twenty two cases were identified (10 male, mean age 59.1 years). Jaundice occurred a median of 17 days after drug commencement, with a median peak bilirubin level of 225 \u03bcmol\/l (range 84\u2013598) and median duration of jaundice 69 days (range 29\u2013150). Two patients had primary biliary cirrhosis and two other patients had persistently abnormal liver biochemistry on follow up. One death occurred in a frail elderly woman despite resolving jaundice. The frequency of jaundice was 1 in 78\u2009209 co-amoxiclav prescriptions. Liver biopsy, available in 12 patients, showed perivenular bilirubinostasis, accompanying reactive ceroid laden macrophages, and portal inflammation with focal injury to interlobular bile ducts. Fourteen of 20 patients had DRB1*1501 compared with 27 of 134 controls (p&lt;2.5\u00d710\n                      <jats:sup>\u20136<\/jats:sup>\n                      ; odds ratio (OR) 9.25; relative risk (RR) 6.43). Of these, seven patients were homozygous for DRB1*1501(p&lt; 10\n                      <jats:sup>\u20138<\/jats:sup>\n                      ; OR 35.54; RR=8.68) compared with two of 134 controls. All patients with DRB1*1501 had the extended haplotype DRB1*1501-DRB5*0101-DQA1*0102-DQB1*0602. There were no clinical or histological differences between genotypes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Co-amoxiclav associated hepatotoxicity may have a genetic basis and be delayed, severe, and prolonged, although complete recovery is usual.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/gut.47.5.717","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T06:32:32Z","timestamp":1027751552000},"page":"717-720","source":"Crossref","is-referenced-by-count":238,"title":["Co-amoxiclav jaundice: clinical and histological features and HLA class II association"],"prefix":"10.1136","volume":"47","author":[{"given":"J","family":"O'Donohue","sequence":"first","affiliation":[{"name":"aDepartment of Gastroenterology, Gartnavel General Hospital, Glasgow G12 0YN, UK, \n\nbUniversity Department of Pathology, Western Infirmary, Glasgow G11 6NT, UK, \n\ncInstitute of Liver Studies, King's College Hospital, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K A","family":"Oien","sequence":"additional","affiliation":[{"name":"aDepartment of Gastroenterology, Gartnavel General Hospital, Glasgow G12 0YN, UK, \n\nbUniversity Department of Pathology, Western Infirmary, Glasgow G11 6NT, UK, \n\ncInstitute of Liver Studies, King's College Hospital, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Donaldson","sequence":"additional","affiliation":[{"name":"aDepartment of Gastroenterology, Gartnavel General Hospital, Glasgow G12 0YN, UK, \n\nbUniversity Department of Pathology, Western Infirmary, Glasgow G11 6NT, UK, \n\ncInstitute of Liver Studies, King's College Hospital, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Underhill","sequence":"additional","affiliation":[{"name":"aDepartment of Gastroenterology, Gartnavel General Hospital, Glasgow G12 0YN, UK, \n\nbUniversity Department of Pathology, Western Infirmary, Glasgow G11 6NT, UK, \n\ncInstitute of Liver Studies, King's College Hospital, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Clare","sequence":"additional","affiliation":[{"name":"aDepartment of Gastroenterology, Gartnavel General Hospital, Glasgow G12 0YN, UK, \n\nbUniversity Department of Pathology, Western Infirmary, Glasgow G11 6NT, UK, \n\ncInstitute of Liver Studies, King's College Hospital, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R N M","family":"MacSween","sequence":"additional","affiliation":[{"name":"aDepartment of Gastroenterology, Gartnavel General Hospital, Glasgow G12 0YN, UK, \n\nbUniversity Department of Pathology, Western Infirmary, Glasgow G11 6NT, UK, \n\ncInstitute of Liver Studies, King's College Hospital, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P R","family":"Mills","sequence":"additional","affiliation":[{"name":"aDepartment of Gastroenterology, Gartnavel General Hospital, Glasgow G12 0YN, UK, \n\nbUniversity Department of Pathology, Western Infirmary, Glasgow G11 6NT, UK, \n\ncInstitute of Liver Studies, King's College Hospital, London SE5 9RS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2000,11,1]]},"reference":[{"key":"2025121222215223000_47.5.717.1","first-page":"1495","article-title":"Cholestatic hepatitis due to amoxicillin and clavulanic acid.","volume":"132","author":"Van Den Broek","year":"1988","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2025121222215223000_47.5.717.2","doi-asserted-by":"crossref","first-page":"285","DOI":"10.5694\/j.1326-5377.1992.tb139752.x","article-title":"Augmentin-induced jaundice with a fatal outcome.","volume":"156","author":"Hebbard","year":"1992","journal-title":"Med J Aust"},{"issue":"Pt 2","key":"2025121222215223000_47.5.717.3","first-page":"400A","article-title":"Augmentin-induced hepato-renal failure and death.","volume":"22","author":"Carter","year":"1995","journal-title":"Hepatology"},{"key":"2025121222215223000_47.5.717.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5085(99)70404-X"},{"key":"2025121222215223000_47.5.717.5","unstructured":"Office of Population (1991) Census of Population. 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