Adverse drug reactions related to amoxicillin alone and in association with clavulanic acid: data from spontaneous reporting in Italy

• Published in: Journal of antimicrobial chemotherapy Vol. 60; no. 1; pp. 121 - 126
• Main Authors: Salvo, Francesco, Polimeni, Giovanni, Moretti, Ugo, Conforti, Anita, Leone, Roberto, Leoni, Olivia, Motola, Domenico, Dusi, Giulia, Caputi, Achille Patrizio
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-07-2007; Oxford Publishing Limited (England)
• Subjects: Adult; Adverse Drug Reaction Reporting Systems - statistics & numerical data; Aged; Amoxicillin - adverse effects; Amoxicillin - therapeutic use; Amoxicillin-Potassium Clavulanate Combination - adverse effects; Amoxicillin-Potassium Clavulanate Combination - therapeutic use; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Databases, Factual - statistics & numerical data; drug safety; Drug Utilization - statistics & numerical data; Female; Humans; Italy; Male; Medical research; Medical sciences; Microbiology; Middle Aged; Odds Ratio; Patient safety; Pharmacology. Drug treatments; Prescription drugs; reporting odds ratio; Side effects; β-lactams; Italy; Europe; β-lactams; drug safety; reporting odds ratio; Drug; Enzyme; Clavulanic acid; Toxicity; Spontaneous; β-Lactams; Enzyme inhibitor; β-Lactamase; Penicillin derivatives; Antibiotic; Amoxicillin; Hydrolases; Antibacterial agent
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkm111

Objectives To analyse an Italian database of spontaneous reporting of suspected adverse drug reactions in order to compare the safety profile of amoxicillin and amoxicillin/clavulanic acid. Methods Data were retrieved from the spontaneous reports collected by six Italian regions (the GIF database) from January 1988 to June 2005. Drug utilization data were also available for the two drugs. The comparison between amoxicillin and amoxicillin/clavulanic acid was made using the χ2 or Student's t-test, when appropriate. Disproportionality in reporting of adverse events was assessed using reporting odds ratio methodology. Results Up to June 2005, the GIF database collected 37 906 reports, of which 1088 were related to amoxicillin/clavulanic acid and 1095 to amoxicillin. The percentage of skin reactions was statistically higher for amoxicillin (82%) than for amoxicillin/clavulanic acid (76%); on the contrary, the percentage of gastrointestinal, hepatic and haematological reactions was significantly higher for amoxicillin/clavulanic acid (13%, 4% and 2%, respectively) than for amoxicillin (7%, 1% and 1%, respectively). Amoxicillin/clavulanic acid seems to be associated with a higher risk of Stevens–Johnson syndrome, purpura and hepatitis than amoxicillin alone. In particular, the reporting rate of hepatitis is on average 9-fold higher for amoxicillin/clavulanic acid than for amoxicillin. Conclusions Analysis shows a different safety profile for the two selected drugs. The combination of amoxicillin/clavulanic acid has been increasingly used in Italy and now represents the most frequently antibiotic prescribed by Italian general practitioners. Given the documented level of inappropriate use of β-lactams in Italy, these results should be taken into account by physicians before prescribing amoxicillin/clavulanic acid to patients.