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Carnitine-associated encephalopathy caused by long-term treatment with an antibiotic containing pivalic acid

Yasuko Makino1, Tokio Sugiura, Tetsuya Ito

  • 1Department of Pediatrics, Toyohashi Municipal Hospital, 50 Hachiken-nishi, Aotake, Toyohashi, Aichi 441-8570, Japan.

Pediatrics
|August 29, 2007
PubMed

Insights

Antibiotics with pivalic acid can cause severe neurological issues like seizures by depleting carnitine. Carnitine supplementation effectively treated these adverse effects in a child, suggesting caution with long-term antibiotic use.

Area of Science:

  • Pediatric Neurology
  • Pharmacology
  • Biochemistry

Background:

  • Pivalic acid-containing antibiotics are used for chronic infections like otitis media.
  • Long-term antibiotic use can lead to potential metabolic disturbances.
  • Neurological adverse effects associated with these antibiotics require further investigation.

Observation:

  • An 18-month-old boy on a 6-month course of a pivalic acid antibiotic developed recurrent seizures and loss of consciousness.
  • Initial treatment with intravenous glucose was ineffective.
  • Laboratory tests revealed hypoglycemia and hypocarnitinemia.

Findings:

  • Intravenous carnitine administration led to rapid recovery of consciousness and neurological function.
  • This case highlights a potential mechanism of carnitine depletion by pivalic acid antibiotics.
  • The findings suggest a direct link between pivalic acid antibiotic exposure and carnitine deficiency-induced neurological symptoms.

Implications:

  • Carnitine deficiency is a critical, treatable complication of long-term pivalic acid antibiotic therapy.
  • Clinicians should consider monitoring carnitine levels in patients on prolonged treatment with these antibiotics.
  • Long-term use of antibiotics containing pivalic acid should be approached with caution due to the risk of severe neurological adverse events.

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