Is loracarbef (Lorabid ) an alternative antibiotic drug in order to avoid liver toxicity?/nBackgrou

Fråga: Is loracarbef (Lorabid ) an alternative antibiotic drug in order to avoid liver toxicity?

Background: A woman has developed an abdominal abscess after surgery of endometriosis. Treatment with amoxicillin-clavulanic acid resulted in liver toxicity and aminotransferase elevations. This side-effect disappeared after treatment had stopped. The use of amoxicillin alone had no effect on the abscess. Therefore treatment with cefpodoxime (Orelox) 400 mg daily was started. About one week later the patient developed liver toxicity again.

Sammanfattning: Cephalosporins and the betalactam derivative loracarbef, which is closely related to the cephalosporins, are known causes to liver toxicity. The risk for development of hepatotoxicity should be weighted against the clinical benefit of using antibiotic treatment. If antibiotics are used, liver function parameters should be closely monitored.

Svar: Liver toxicity due to treatment with different cephalosporins has been dealt with in Drugline before. All cephalosporins such as cefpodoxime have been reported to cause increases in serum transaminases and alkaline phosphatase (1). These transient liver enzyme elevations have been reported in 0.5-5.5 per cent of the recipients. In general, a complete recovery is seen after discontinuation of cephalosporin treatment (2).

Loracarbef is a betalactam derivative closely related to cephalosporins (3). According to (4) liver transaminase elevations are found in less than 1/1000 patients. Other betalactam antibiotics have been reported to cause liver enzyme elevations and cholestasis (3).

The manufacturer is aware of at least 10 cases of liver toxicity and cholestasis associated with loracarbef, although other factors may have contributed in these cases. The files of the Swedish Adverse Drug Reactions Advisory Committee contain four cases of liver toxicity in connection to loracarbef treatment. Among these are two cases of transaminase elevations and single cases of cholestasis and mixed liver reaction. 1 Drugline nr 11841 (year ) 2 Stricker BH, Drug induced hepatic injury. 1992; 2nd ed 3 Drugline nr 12563 (year ) 4 FASS 1997 (The swedish catalogue of approved medical products)