PMID: 16503323Mar 1, 2006Paper

Formation of rectus sheath hematoma with antibiotic use and warfarin therapy: a case report

The American Journal of Geriatric Pharmacotherapy
Martina KellyStephen Byrne

Abstract

This case is reported to inform physicians of a case of amoxicillin/clavulanate potassium use in a patient taking warfarin and the subsequent alteration (prolongation) in the international normalized ratio (INR) that resulted in the formation of a rectus sheath hematoma (RSH). A 75-year-old man receiving long-term warfarin therapy developed a lower respiratory tract infection with paroxysmal coughing that was treated with oral amoxicillin 250 mg/clavulanate potassium 125 mg TID for 7 days. In the 3 days after completing antibiotic treatment, he developed increasingly severe lower abdominal pain that was clinically diagnosed as RSH. The patient was admitted to the local hospital for confirmation of the diagnosis and appropriate management. Before this episode, his INR was consistently within therapeutic range (2-3); on admission it had risen to 5.7. His condition was managed conservatively, and he was discharged home 6 days postadmission. This case is reported to highlight the potential interaction between warfarin and amoxicillin/clavulanate potassium and subsequent RSH formation. The potential mechanism of the interaction between amoxicillin/clavulanate potassium and warfarin may be either pharmacokinetic (via metabolism in th...Continue Reading

References

Jan 2, 2003·Postgraduate Medical Journal·D MaharajV Naraynsingh
Mar 18, 2003·The Annals of Pharmacotherapy·Liya DavydovLewis J Cuni
May 25, 2005·Archives of Internal Medicine·Anne M HolbrookPhilip S Wells

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Citations

Jan 1, 2011·BMJ Case Reports·Takahisa FujikawaAkira Tanaka
Feb 5, 2014·The American Journal of Case Reports·Timothy R LarsenChristopher Durando
Feb 25, 2009·Expert Opinion on Drug Safety·Francesco SalvoGiovanni Polimeni
Jul 4, 2015·Journal of Clinical Pharmacology·Mahmoud I Abdel-AzizTahani H Elfaham
Jan 12, 2011·British Journal of Clinical Pharmacology·Qian ZhangStéphane Mouly
Jul 4, 2015·Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition·Amber E King, Kyle Strnad

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