A 42-year-old salesman was admitted with a diagnosis of pneumonia. He is allergic to erythromycin. X-ray shows a hazy opacity in the right lower and mid-zone. Blood investigations show hyponatremia and slight rise in the level of liver aminotransferase. After starting the medication on the fifth day he became acutely jaundiced and his liver aminotransferase level became very high. He also complained of discoloration of his urine, which did not show hematuria on dipstick testing.
Which of the following drugs probably caused the jaundice?
A . Ciprofloxacin
B . Clarithromycin
C . Amoxicillin
D . Rifampicin
E . Flucloxacillin
Answer: D
Explanation:
This patient has legionella pneumonia and therefore rifampicin was prescribed.
However, rifampicin, as it is a hepatic enzyme inducer, can lead to acute jaundice with a rise in the liver aminotransferase level. It also causes red or orange discoloration of the urine and other body fluids. Patient should be warned about this side-effect. Rifampicin is generally not used as a monotherapy to treat legionella pneumonia. As this patient is allergic to the macrolides, ciprofloxacin is the other drug of choice. Monotherapy with rifampicin is associated with the development of resistance.
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