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Recurrent pancreatitis after trimethoprim-sulfamethoxazole rechallenge
M W J Versleijen1, A H J Naber, N P Riksen
1Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
The Netherlands Journal of Medicine
|August 12, 2005
Summary
Trimethoprim-sulfamethoxazole (TMP/SMX) can cause recurrent acute pancreatitis, even after years of use. Discontinue TMP/SMX if pancreatitis is suspected to avoid further complications.
Area of Science:
- Pharmacology
- Gastroenterology
- Nephrology
Background:
- Trimethoprim-sulfamethoxazole (TMP/SMX) is commonly prescribed for urinary tract infections and prophylaxis.
- Long-term antibiotic use can be associated with various adverse drug reactions.
- Ureterosigmoidostomy patients often require chronic antibiotic prophylaxis.
Observation:
- A female patient with a history of ureterosigmoidostomy developed recurrent acute pancreatitis.
- Pancreatitis episodes consistently correlated with trimethoprim-sulfamethoxazole (TMP/SMX) use.
- No alternative etiologies for pancreatitis were identified.
Findings:
- A causal link between TMP/SMX and acute pancreatitis was established.
- The patient experienced pancreatitis relapse upon TMP/SMX rechallenge, confirming causality.
- This case highlights that TMP/SMX-induced pancreatitis can manifest even after prolonged treatment.
Implications:
- Clinicians should consider TMP/SMX as a potential cause of acute pancreatitis in susceptible patients.
- Discontinuation of TMP/SMX is crucial if a causal relationship is suspected.
- Awareness of this adverse effect is important for long-term TMP/SMX management.
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