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Clavulanate Cholestatic DILI — RACP Adult Medicine MCQ

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ModerateGastroenterologyClavulanate Cholestatic DILIRACP Adult Medicine

A 40-year-old woman on amoxicillin-clavulanate for 10 days develops jaundice 2 weeks after completing the course. ALP is 550 U/L, GGT 380 U/L, ALT is 120 U/L. Bilirubin is predominantly conjugated (180 μmol/L). Ultrasound shows no biliary dilatation. Hepatitis serology negative. What is the most likely hepatotoxicity pattern?

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Correct answer: C — Cholestatic drug-induced liver injury

Elevated ALP/GGT with only mildly elevated ALT (R-factor <2 = cholestatic) and conjugated hyperbilirubinaemia after amoxicillin-clavulanate is cholestatic DILI. Clavulanate is the hepatotoxic component. Cholestatic DILI characteristically presents during or shortly after the course and may be delayed (up to 6 weeks). It generally resolves spontaneously but can take months.

Reference: AASLD – 2024 – DILI Guidelines; eTG Gastrointestinal 2024