JAC Advance Access published online on April 21, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm111
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Adverse drug reactions related to amoxicillin alone and in association with clavulanic acid: data from spontaneous reporting in Italy
1 Department of Clinical and Experimental Medicine and Pharmacology, Section of Pharmacology, University of Messina, Messina, Italy 2 Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Centro Neurolesi ‘Bonino-Pulejo’, Messina, Italy 3 Clinical Pharmacology Unit, Reference Centre for Education and Communication Within the WHO Programme for International Drug Monitoring, University of Verona, Verona, Italy 4 Lombardy Centre of Pharmacovigilance, Milan, Italy 5 Department of Pharmacology, Interuniversity Research Centre for Pharmacoepidemiology, University of Bologna, Bologna, Italy 6 Pharmacy Unit, Santa Maria del Carmine Hospital, Rovereto, Trento, Italy
Received 12 January 2007; returned 3 February 2007; revised 19 March 2007; accepted 21 March 2007
* Corresponding author. Tel: +39-090-2213878; Fax: +39-090-2213300; E-mail: fsalvo{at}unime.it
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 
2 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 ß-lactams in Italy, these results should be taken into account by physicians before prescribing amoxicillin/clavulanic acid to patients.
Key Words: drug safety , ß-lactams , reporting odds ratio