Unintentional Azithromycin Overdose and Prolonged Therapy with Amoxicillin/Clavulanate without the Development of Hepatotoxicity in a Patient with Type I Diabetes: Case Description

The use of antibiotics is often associated with the development of drug-induced liver injury (DILI). It is known that amoxicillin/clavulanate (AMC) and macrolides can cause DILI. Case presentation. A 48-year-old female with severe type I diabetes mellitus and carbuncle of scalp was treated in outpatient department with azithromycin 1.0 g b.i.d. for 4.5 days (total course dose - 9.0 g; this case should be considered as inadvertent azithromycin overdose) and then with a standard dose of AMC (875/125 mg b.i.d.) for 32 days in the hospital. Clinical chemistry monitoring for more than two months did not reveal any signs of DILI. Conclusion. Despite the anticipated hepatic injury as consequence of significant azithromycin overdose and long-term (>30 days) standard dose AMC treatment no DILI developed. This case demonstrates that a genetic predisposition is necessary for the development of DILI in addition to the well-known risk factors such as dose and/or duration of treatment.