Un common side effect

CO-AMOXICLAV

MARIA ULFA
051815153012
 KLASIFIKASI ESO

• ONSET: LATEN

• TINGKAT KEPARAHAN:
MODERATE
 Klasifikasi

• Type B
• Very rare event
• Hanya terjadi pada elderly > 50 th dan pria
• Mekanisme imun alergi/ Idiosyncratic
respon
• Cholestasis akut
 Mekanisme ESO
• Asam klavukanat (AC) di eksresikan melalui renal dan liver
sehingga lebih hepatotoksik dibanding amox saja. Terjadi
reaksi hipersensitivitas dan mengarah ke mekanisme alergi
imun atau disebabkan oleh respon idiosinkratik dari obat.
Dimana neoantigen dari AC akan berikatan dengan hapten
(sitokrom) yang berada di hepatosit sehingga terjadi
haptenisasi yang dapat merangsang APC pada HLA II atau
MHC II DRB1* 1501-DQB1* 0602 dan HLA I atau MHC I
alleles A*3002 and B*1801 merangsang aktivasi sitotoksik
Tc atau CD8 dan CD4
Cara penanganan
• Pemberhentian obat
 DAFTAR PUSTAKA
• Delemos Andrew S., et al., 2016, Amoxicillin-Clavulanate-Induced Liver Injury, HHS
Public Access: Dig Dis Sci: August; 61(8): 2406-2416. http://doi:10.1007/s10620-016-
4121-6.
• Donati Monia et al., 2017, Liver Injury due to Amoxicillin vs. Amoxicillin/ Clavulanate: A
Subgroup Analysis of Drug-Induced Liver Injury Case-Control Study in Italy, Journal
Hepatology and Gastrointestinal Disorders, Vol: 3 Issue 1.
• Fontana Robert J., 2014, Phatogenesis of Idiosyncratic Drug-Induced Liver Injury and
Clinical Perspective, NIH Public Access: Gastroenterology. 2014 April ; 146(4): 914–928.
doi:10.1053/j.gastro.2013.12.032.
• Fourea D.M., et al, 2014, Comparative analysis of portal hepatic infiltrating leucocytes in
acute drug-induced liver injury, idiopathic autoimmune and viral hepatitis, British Society
for Immunology, Clinical and Experimental Immunology, 180: 40–51
• Han Derick et al, 2013, Regulation of drug-induced liver injury by signal transduction
pathways: critical role of mitochondria, Trends Pharmacol Sci, April ; 34(4): 243–253.
doi:10.1016/j.tips.2013.01.009.
• Suzuki Ayako et al, 2015, Comedications alter drug-induced liver injury reporting
frequency: Data mining in the WHO VigiBaseTM, Regul Toxicol Pharmacol, August;
72(3): 481-490. http://dx.doi.org/10.1016/j.yrtph.2015.05.004.
• Suleman Shams et al., 2014, Gastrointestinal and Hepatotoxic Side Effect of Co-
Amoxiclav in Adults, JSZMC; 5(3): 648-651.
• Thomas Vinay Mathew and Thomas-Eapen Neena, 2017, An Uncommon Side Effect of a
Comonly Used Antibiotic: Amoxicillin- Clavulanic Acid Induced Hepatitis. The Korean
Academy of Family Medicine; 38: 307-310. https://doi.org/10.4082/kjfm.2017.38.5.307.