• Seyfettin Köklü, Aydin S Köksal, Mehmet Asil, Halil Kiyici, Sahin Coban, and Mehmet Arhan.
• Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. gskoklu@yahoo.com
• Ann Pharmacother. 2004 Dec 1;38(12):2055-8.

ObjectiveTo present a single case of sulbactam/ampicillin-induced chronic cholestasis and a literature review of antibiotic-associated chronic cholestasis.Case SummaryA 74-year-old man with Hodgkin's disease in remission developed severe and prolonged cholestasis after treatment with sulbactam/ampicillin 750 mg twice daily for 7 days. All other etiologies, including Hodgkin's disease, were appropriately ruled out and the cholestasis was ascribed to sulbactam/ampicillin treatment. The patient improved gradually and became asymptomatic 7 months after the last dose of sulbactam/ampicillin. According to the Naranjo probability scale, sulbactam/ampicillin was the probable cause of the cholestasis.DiscussionAmpicillin, a semisynthetic penicillin, has rarely been associated with hepatic injury when used alone. Hepatocellular and acute cholestatic injury due to ampicillin have been described. Cholestasis secondary to sulbactam/ampicillin use has not been previously reported.ConclusionsSulbactam/ampicillin, one of the most widely used antibiotics, may cause chronic cholestatic hepatitis. Clinicians should be aware of this adverse affect and consider it during diagnostic workup of liver injury.

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