Severe Hepatitis Associated With Oxacillin Therapy A 6-year-old girl had fever, abdominal pain, and severe anicteric hepatitis during intravenous oxacillin therapy for staphylococcal osteomyelitis. She had greatly elevated liver enzymes, prolonged prothrombin time, leukopenia, and eosinophilia. Clinical symptoms resolved and laboratory data returned to normal after withdrawing oxacillin and substituting cefazolin. This hepatotoxicity appears to be specific to oxacillin and not to other

-lactams. Monitoring liver function tests during oxacillin therapy, especially in patients receiving prolonged treatment, may be warranted.
Hepatic injury, manifested as elevation of transaminases or cholestatic jaundice or both, has been associated with many drugs. Several antibiotics can cause hepatic injury. Penicillins commonly cause hypersensitivity reactions but rarely produce hepatic injury. High doses of semisynthetic penicillins may cause asymptomatic elevation of liver enzymes. Toxic hepatitis and elevation of liver enzymes have been described after the use of ampicillin, carbenicillin, and oxacillin. Oxacillin-induced hepatitis has been reported in adults with underlying medical risk factors. However, few cases of asymptomatic elevation of liver enzymes in association with oxacillin therapy have been reported in children. We report an unusually severe but reversible acute hepatitis in a child receiving oxacillin therapy.