Side effects, as with other penicillins, are uncommon and mainly of a mild and transitory nature.
Hypersensitivity Reactions: If any hypersensitivity occurs, the treatment should be discontinued. Skin rash, pruritus and urticaria have been reported occasionally. Rarely, skin reactions eg, erythema multiforme and Stevens-Johnson syndrome, toxic epidermal necrolysis and bullous and exfoliative dermatitis have been reported.
As with other antibiotics, severe allergic reactions including angioneurotic oedema, anaphylaxis (see Precautions), serum sickness and hypersensitivity vasculitis have been reported rarely.
Interstitial nephritis can occur rarely.
Gastrointestinal Reactions: Effects include nausea, vomiting and diarrhea. Intestinal candidiasis and antibiotic-associated colitis (including pseudomembranous colitis and hemorrhagic colitis) have been reported rarely.
Hepatic Effects: A moderate rise in AST and/or ALT has been occasionally noted but the significance of this is unclear. As with other β-lactam antibiotics, hepatitis and cholestatic jaundice have been reported rarely.
Hematological Effects: As with other β-lactams, eosinophilia, reversible leucopenia (including severe neutropenia or agranulocytosis), reversible thrombocytopenia and hemolytic anemia have been reported rarely. Prolongation of bleeding time and prothrombin time has also been reported rarely (see Precautions).
Central Nervous System Effects: Central nervous system effects have been seen rarely. They include hyperkinesia, dizziness and convulsions, reversible hyperactivity, agitation, anxiety, insomnia, confusion. Convulsions may occur in patients with impaired renal function or in those receiving high doses.
Miscellaneous: Superficial tooth discoloration has been reported rarely and mostly with chewable tablets. It can usually be removed by brushing.
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