amoxicillin-potassium-clavulanate-combination and Pancreatitis

Acute pancreatitis is an acute inflammation of the pancreas that varies in severity from mild to life threatening usually requiring hospitalization. The true incidence of drug-induced pancreatitis (DIP) is indeterminate due to the inadequate documentation of case reports of DIP. Here we present the case of amoxicillin/clavulanic acid-induced pancreatitis in a previously healthy male after excluding all other causes of pancreatitis.. A 58-year-old Caucasian man presenting for acute sharp abdominal pain with associated nausea and heaves. Pain was non-radiating and worsening with movement. Patient had no constitutional symptoms. The only medication he received prior to presentation was amoxicillin/clavulanic acid as prophylaxis for a dental procedure with his symptoms starting on day 9th of therapy. Laboratory studies revealed mild leukocytosis, increased levels of serum lipase, amylase, and C-reactive protein (CRP). Abdominal computed tomography (CT) was notable for acute pancreatitis with no pseudocyst formation. Hence, patient was diagnosed with mild acute pancreatitis that was treated with aggressive intravenous (IV) hydration and pain management with bowel rest of 2 days duration and significant improvement being noticed within 72 h. On further questioning, patient recalled that several years ago he had similar abdominal pain that developed after taking amoxicillin/clavulanic acid but did not seek medical attention at that time and the pain resolved within few days while abstaining from food intake. All other causes of pancreatitis were ruled out in this patient who is non-alcoholic, non-smoker, and never had gallstones. Abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP) eliminated out the possibility of gallstones, biliary ductal dilatation, or choledocholithiasis. Patient had no hypertriglyceridemia nor hypercalcemia, never had endoscopic retrograde cholangiopancreatography (ERCP), never took steroids, has no known malignancy, infection, trauma, or exposure to scorpions.. This case describes a patient with DIP after the intake of amoxicillin/clavulanic acid and when all other common causes of acute pancreatitis were excluded. Only two other case reports were available through literature review regarding amoxicillin/clavulanic acid- induced pancreatitis. We again stress on the importance of identifying and reporting cases of DIP to raise awareness among physicians and clinicians.

Topics: Abdominal Pain; Amoxicillin-Potassium Clavulanate Combination; beta-Lactamase Inhibitors; Cholangiopancreatography, Magnetic Resonance; Humans; Male; Middle Aged; Nausea; Pancreatitis; Tomography, X-Ray Computed; Ultrasonography; Vomiting

Acute pancreatitis is rare in pregnancy, with an estimated incidence of 1 in 1000-3000 pregnancies. Gallstones are the commonest cause. Mortality and morbidity associated with pancreatitis have declined as diagnosis and management options improve. Presentation usually occurs in the third trimester or early postpartum period with severe epigastric pain, nausea, vomiting, anorexia and fever. Blood investigations show an elevated white cell count and increased liver enzyme concentrations. Ultrasound is safe but has lower sensitivity than computerised tomography for detecting gallstones. Management during pregnancy has traditionally been conservative, followed by cholecystectomy after delivery. Recurrence of pancreatitis during pregnancy may necessitate more urgent surgery. The second trimester is considered the safest for surgery, with early involvement of intensive care as the condition can deteriorate rapidly. We present three cases managed in our unit over a six-month period that illustrate the spectrum of disease and the successful use of a multidisciplinary team approach.

Topics: Acute Disease; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cesarean Section; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Cholecystectomy; Female; Gentamicins; Humans; Magnetic Resonance Imaging; Pancreas; Pancreatitis; Pregnancy; Pregnancy Complications; Ultrasonography

Abscess formation in chronic pancreatitis is rare and the pancreas and liver are the most frequent localizations. We present a novel case of splenic abscess in chronic pancreatitis that led to diabetic ketoacidosis in an alcoholic patient. Percutaneous drainage and antibiotic treatment sufficed to resolve completely the abscess.

Topics: Abscess; Adult; Alcoholism; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Calcinosis; Chronic Disease; Diabetic Ketoacidosis; Drainage; Drug Therapy, Combination; Gentamicins; Humans; Male; Pancreatitis; Splenic Diseases

A case of cholestatic jaundice following treatment with Augmentin is reported. The awareness of hepatotoxicity due to drug should help to avoid unnecessary invasive procedures in the evaluation of this reversible condition.

Topics: Acute Disease; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Cholestasis; Clavulanic Acids; Drug Therapy, Combination; Humans; Male; Middle Aged; Pancreatitis