Document Detail


Severe and protracted hypoglycaemia associated with co-trimoxazole use.
MedLine Citation:
PMID:  16500599     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Co-trimoxazole (trimethoprim-sulfamethoxazole) is a commonly prescribed antimicrobial agent. Although it is well tolerated in most patients, serious adverse events related to its use have been described. Hypoglycaemia is a rare but potentially life-threatening complication of therapy. We describe a case of refractory hypoglycaemia complicated by seizure associated with co-trimoxazole for the treatment of Pneumocystis carinii pneumonia in a patient with AIDS. We also review 13 previously reported cases of co-trimoxazole-induced hypoglycaemia. Among this patient population, renal insufficiency was the most prevalent predisposing risk factor (93%). The mean daily dose of co-trimoxazole was 4.5 double strength (160 mg trimethoprim/800 mg sulfamethoxazole) tablets per day. Serum insulin levels were raised or inappropriately normal in 88% of cases in which they were measured, suggesting a sulfonylurea-like effect of co-trimoxazole as the mechanism of hypoglycaemia. All cases required intravenous glucose administration, and 43% experienced protracted (>12 hours) hypoglycaemia. Dosage adjustments should be made when prescribing co-trimoxazole to patients with renal dysfunction.
Authors:
Elizabeth L Strevel; Ayelet Kuper; Wayne L Gold
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Publication Detail:
Type:  Case Reports; Clinical Conference; Journal Article    
Journal Detail:
Title:  The Lancet infectious diseases     Volume:  6     ISSN:  1473-3099     ISO Abbreviation:  Lancet Infect Dis     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-02-27     Completed Date:  2006-04-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101130150     Medline TA:  Lancet Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  178-82     Citation Subset:  IM    
Affiliation:
University of Toronto, Toronto, Canada.
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections / drug therapy*
Adult
Aged
Aged, 80 and over
Antifungal Agents / administration & dosage,  adverse effects*,  pharmacology
Female
Glucose / administration & dosage
Humans
Hypoglycemia / chemically induced*
Infant
Insulin / blood
Male
Middle Aged
Pneumonia, Pneumocystis / drug therapy*
Risk Factors
Seizures / etiology
Trimethoprim-Sulfamethoxazole Combination / administration & dosage,  adverse effects*,  pharmacology
Chemical
Reg. No./Substance:
0/Antifungal Agents; 11061-68-0/Insulin; 50-99-7/Glucose; 8064-90-2/Trimethoprim-Sulfamethoxazole Combination

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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