Abstract
Objective: Trimethoprim-sulfamethoxazole (co-trimoxazole) is a commonly used broad-spectrum antibiotic, but it can be associated with potentially serious adverse effects, often not recognized by clinicians. This is a relevant problem in elderly patients, who are particularly susceptible to adverse drug reactions. Moreover, multiple medications taken by older people increase the risk for adverse drug reactions and drug-drug interactions. Case report: We report the case of an 85-year-old man with diabetes mellitus who attended the emergency room with severe hypoglycemia that persisted despite multiple intravenous bolus doses and continuous infusion of glucose. He needed hospital admission to stabilize glycemia. The patient, a nursing home resident, was being treated with co-trimoxazole for an uncomplicated urinary tract infection, but was also taking multiple additional drugs for his co-morbidities. After co-trimoxazole was discontinued, plasma glucose levels slowly stabilized within the normal range. A diagnosis of prolonged and refractory hypoglycemia induced mainly by the antimicrobial agent was made, with additional contribution from multiple other drugs. No further episodes of hypoglycemia occurred during the next 6 months of follow-up. Conclusion: This case study illustrates once more the critical importance of prescription appropriateness in elderly patients with multiple morbidities in terms of type and dosage of drugs, in order to avoid serious adverse reactions.
| Original language | English |
|---|---|
| Pages (from-to) | 86-89 |
| Number of pages | 4 |
| Journal | International Journal of Clinical Pharmacology and Therapeutics |
| Volume | 56 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Jan 1 2018 |
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Keywords
- Elderly
- hypoglycemia
- Polypharmacy
- Trimethoprim-sulfamethoxazole
ASJC Scopus subject areas
- Pharmacology
- Pharmacology (medical)
Cite this
Persistent and severe hypoglycemia associated with trimethoprim-sulfamethoxazole in a frail diabetic man on polypharmacy : A case report and literature review. / Rossio, Raffaella; Arcudi, Sara; Peyvandi, Flora; Piconi, Stefania.
In: International Journal of Clinical Pharmacology and Therapeutics, Vol. 56, No. 2, 01.01.2018, p. 86-89.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Persistent and severe hypoglycemia associated with trimethoprim-sulfamethoxazole in a frail diabetic man on polypharmacy
T2 - A case report and literature review
AU - Rossio, Raffaella
AU - Arcudi, Sara
AU - Peyvandi, Flora
AU - Piconi, Stefania
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Objective: Trimethoprim-sulfamethoxazole (co-trimoxazole) is a commonly used broad-spectrum antibiotic, but it can be associated with potentially serious adverse effects, often not recognized by clinicians. This is a relevant problem in elderly patients, who are particularly susceptible to adverse drug reactions. Moreover, multiple medications taken by older people increase the risk for adverse drug reactions and drug-drug interactions. Case report: We report the case of an 85-year-old man with diabetes mellitus who attended the emergency room with severe hypoglycemia that persisted despite multiple intravenous bolus doses and continuous infusion of glucose. He needed hospital admission to stabilize glycemia. The patient, a nursing home resident, was being treated with co-trimoxazole for an uncomplicated urinary tract infection, but was also taking multiple additional drugs for his co-morbidities. After co-trimoxazole was discontinued, plasma glucose levels slowly stabilized within the normal range. A diagnosis of prolonged and refractory hypoglycemia induced mainly by the antimicrobial agent was made, with additional contribution from multiple other drugs. No further episodes of hypoglycemia occurred during the next 6 months of follow-up. Conclusion: This case study illustrates once more the critical importance of prescription appropriateness in elderly patients with multiple morbidities in terms of type and dosage of drugs, in order to avoid serious adverse reactions.
AB - Objective: Trimethoprim-sulfamethoxazole (co-trimoxazole) is a commonly used broad-spectrum antibiotic, but it can be associated with potentially serious adverse effects, often not recognized by clinicians. This is a relevant problem in elderly patients, who are particularly susceptible to adverse drug reactions. Moreover, multiple medications taken by older people increase the risk for adverse drug reactions and drug-drug interactions. Case report: We report the case of an 85-year-old man with diabetes mellitus who attended the emergency room with severe hypoglycemia that persisted despite multiple intravenous bolus doses and continuous infusion of glucose. He needed hospital admission to stabilize glycemia. The patient, a nursing home resident, was being treated with co-trimoxazole for an uncomplicated urinary tract infection, but was also taking multiple additional drugs for his co-morbidities. After co-trimoxazole was discontinued, plasma glucose levels slowly stabilized within the normal range. A diagnosis of prolonged and refractory hypoglycemia induced mainly by the antimicrobial agent was made, with additional contribution from multiple other drugs. No further episodes of hypoglycemia occurred during the next 6 months of follow-up. Conclusion: This case study illustrates once more the critical importance of prescription appropriateness in elderly patients with multiple morbidities in terms of type and dosage of drugs, in order to avoid serious adverse reactions.
KW - Elderly
KW - hypoglycemia
KW - Polypharmacy
KW - Trimethoprim-sulfamethoxazole
UR - http://www.scopus.com/inward/record.url?scp=85041048406&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85041048406&partnerID=8YFLogxK
U2 - 10.5414/CP203084
DO - 10.5414/CP203084
M3 - Review article
AN - SCOPUS:85041048406
VL - 56
SP - 86
EP - 89
JO - International Journal of Clinical Pharmacology and Therapeutics
JF - International Journal of Clinical Pharmacology and Therapeutics
SN - 0174-4879
IS - 2
ER -