Which antibiotic ester form is associated with allergic cholestatic hepatitis?

Which antibiotic ester form is associated with allergic cholestatic hepatitis?

• A. Chloramphenicol
• B. Clindamycin
• C. Penicillin G
• D. Erythromycin Estolate

Answer: (D)

Allergic cholestatic hepatitis is a drug-induced liver injury where bile flow is disrupted, often through an immune-related reaction in the biliary system. The antibiotic ester form classically linked to this specific reaction is erythromycin estolate. This esterified macrolide was associated with a higher risk of cholestasis and hypersensitivity-type liver injury than erythromycin base or other antibiotics. Patients typically develop jaundice with signs of cholestasis after some exposure to the drug. The other antibiotics listed have different primary toxicities or mechanisms (chloramphenicol with bone marrow suppression, clindamycin hepatotoxicity is rare, penicillin G can cause various hypersensitivity reactions) and are not the classic estolate-associated cause of allergic cholestatic hepatitis.

Allergic cholestatic hepatitis is a drug-induced liver injury where bile flow is disrupted, often through an immune-related reaction in the biliary system. The antibiotic ester form classically linked to this specific reaction is erythromycin estolate. This esterified macrolide was associated with a higher risk of cholestasis and hypersensitivity-type liver injury than erythromycin base or other antibiotics. Patients typically develop jaundice with signs of cholestasis after some exposure to the drug. The other antibiotics listed have different primary toxicities or mechanisms (chloramphenicol with bone marrow suppression, clindamycin hepatotoxicity is rare, penicillin G can cause various hypersensitivity reactions) and are not the classic estolate-associated cause of allergic cholestatic hepatitis.