Ann Intern Med -- Rapid Responses for Clay et al., 144 (6) 415-420

Established in 1927 by the American College of Physicians

Rapid Responses to:

Articles:
Kimberly D. Clay, John S. Hanson, Scott D. Pope, Richard W. Rissmiller, Preston P. Purdum, III, and Peter M. Banks
Brief Communication: Severe Hepatotoxicity of Telithromycin: Three Case Reports and Literature Review
Ann Intern Med 2006; 144: 415-420 [Abstract] [Full text] [PDF]

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Electronic letters published:

Re: Clarifications on case reports: Kimberly D. Clay (15 June 2006)

Clarifications on case reports: Joseph S. Bertino (21 February 2006)

Re: Clarifications on case reports 15 June 2006

Kimberly D. Clay,
MD,MPH
Carolinas Medical Center
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Re: Re: Clarifications on case reports

Kimberly.Clay{at}carolinashealthcare.org Kimberly D. Clay

To the Editor:
In case one, the patient started to notice dark urine on day two of treatment with telithromycin. It was when his wife noted continued symptoms on day 3 that the patient decided to stop the medication. It was a week later when the patient presented to his physician that the laboratory tests were obtained and abnormalities were noted.
With respect to case 3, I would say that the levels of acetaminophen, salicylate and ethylene glycol were negative which were expected based on the history given by the patient.
Conflict of Interest:
None declared

Clarifications on case reports 21 February 2006

Joseph S. Bertino,
Pharm.D.
Ordway Research Institute
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Re: Clarifications on case reports

jbertino{at}ordwayresearch.org Joseph S. Bertino

To the Editor:
While the case reports of possible telithromycin induced hepatic toxicity were of interest, some clarifications are needed from the authors. In case 1, the authors report that the patient presented with a 4 day history of dark urine, jaundice and malaise that started on the second day of telithromycin therapy. However, the authors then state that the drug was "withdrawn after 3 days of therapy" when laboratory results (presumably obtained at the time of patient presentation) were obtained. The time course is confusing as reported.
In case 3, the authors note that "acetaminophen, salicylate and ethylene glycol were subsequently found to be normal." Generally, there are no "normal" concentrations of acetaminophen and salicylate (unless the patient was taking these medications, in that case "normal ranges" may be appropriate). However the case report did not suggest that the patient was taking either of these medications. While suggestions about treatment of ethylene glycol ingestion recommend monitoring serum concentrations (along with a host of other things) to guide treatment, ethylene glycol is generally not found in the body unless there has been an exposure (deliberate or accidental)(1). This also needs clarification for readers.
1. Barceloux DG, Krenzelok EP, Olson K, Watson W. American Academy of Clinical Toxicology Practice Guidelines on the Treatment of Ethylene Glycol Poisoning. Ad Hoc Committee.J Toxicol Clin Toxicol. 1999;37(5):537- 60.
Conflict of Interest:
None declared