From the Research
Flucloxacillin can induce cholecystitis, specifically a condition known as acalculous cholecystitis, as a rare adverse effect, as supported by the study published in 2005 1. This medication is a penicillin antibiotic commonly used to treat infections caused by susceptible gram-positive bacteria, particularly Staphylococcus aureus. The mechanism behind flucloxacillin-induced cholecystitis involves the drug's concentration and excretion in bile, which can cause direct irritation to the gallbladder wall or trigger an immunological reaction. Some key points to consider include:
- Symptoms typically develop within days to weeks of starting treatment and include right upper quadrant pain, fever, nausea, and abnormal liver function tests.
- If a patient on flucloxacillin develops these symptoms, the medication should be discontinued immediately and alternative antibiotics considered.
- Diagnosis is confirmed through imaging studies such as ultrasound or CT scan showing gallbladder inflammation without stones.
- Management involves stopping the offending drug, providing supportive care, and in severe cases, surgical intervention may be necessary.
- Healthcare providers should maintain a high index of suspicion for this adverse effect, especially in patients with risk factors such as prolonged treatment courses or high doses of flucloxacillin, as highlighted in the study published in 1989 2 and 2005 1. The risk of cholestatic liver disease associated with flucloxacillin has been quantified in a cohort study using data from the UK General Practice Research Database, which found that the risk of cholestatic liver disease per 100 000 first-time users was 8.5 in the 1-45 days after starting flucloxacillin 1. Additionally, a review of gallbladder disorders published in 2021 provides a comprehensive overview of the clinical presentation, pathophysiology, diagnostic evaluation, and management of various gallbladder conditions, including acalculous cholecystitis 3. However, the most relevant and recent study to this question is the one published in 2005 1, which provides strong evidence for the association between flucloxacillin and cholecystitis.