trimethoprim--sulfamethoxazole-drug-combination and Cholelithiasis

Two patients, a girl and a boy, both aged 8.5 years, presented with serious side effects caused by ceftriaxone and co-trimoxazole, respectively. The first patientwas treated with ceftriaxone (100 mg/kg/day with a body weight of 35.6 kg) on suspicion of a neuroborreliosis, but developed an acute cholecystitis with cholelithiasis 3 weeks after the antibiotic had been withdrawn. He underwent a laparoscopic cholecystectomy. Ceftriaxone binds calcium in the biliary tract, forming biliary sludge or stones. The second patient developed thrombocytopenia during treatment with co-trimoxazole (58 mg/kg/day with a body weight of 25.4 kg) because of a urinary-tract infection. After discontinuation of the co-trimoxazole the thrombocytopenia resolved spontaneously. The pathophysiological mechanism involved may be either a direct toxic effect of trimethoprim or an immune-mediated reaction to sulfamethoxazole. According to current guidelines, the dosage of the drug was too high in both cases. It is important to ensure a correct dosage in children, since side effects are potentially dose-related.

Topics: Anti-Bacterial Agents; Body Weight; Ceftriaxone; Child; Cholelithiasis; Dose-Response Relationship, Drug; Female; Humans; Male; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Abdominal Pain; Acquired Immunodeficiency Syndrome; Acute Disease; Adult; Cholelithiasis; Cryptosporidiosis; Humans; Male; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination

In a 84-year-old woman extraintestinal infection by non-OI Vibrio cholerae was diagnosed. She had septicaemia with cholangitis and cholecysto- and choledocholithiasis. Until now 26 patients with non-OI V. cholerae septicaemia have been reported. Most had an underlying disease, usually a chronic liver disease or haematological malignancy. These disorders were not present in our patient. She was treated with co-trimoxazole and afterwards she underwent a cholecystectomy and common bile duct exploration. At the time of operation no non-OI V. cholerae could be isolated from the gallbladder or the bile from the common bile duct. A possible cause of the infection was a herring which the patient had eaten six weeks before hospital admission.

Topics: Aged; Aged, 80 and over; Cholangitis; Cholelithiasis; Cholera; Female; Gallstones; Humans; Serotyping; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae