trimethoprim--sulfamethoxazole-drug-combination and Malabsorption-Syndromes

Topics: Adult; Anti-Infective Agents; Diarrhea; Humans; Isosporiasis; Malabsorption Syndromes; Male; Trimethoprim, Sulfamethoxazole Drug Combination

A 24 year-old patient with a short-bowel syndrome receiving home parenteral nutrition in addition to oral feeding for 32 months was treated by oral trimethoprim-sulfamethoxazole for urinary tract infection. Three days later, he developed neurologic disorders associated with severe hyperchloremic acidosis and high plasma level of D-lactate. This is a rare complication of intestinal malabsorption due to small bowel by-pass or extensive resection due to transient alteration of intestinal microflora induced by the oral antibiotic treatment. Diagnosis requires a high indice of suspicion.

Topics: Acidosis, Lactic; Adult; Humans; Intestine, Small; Lactates; Malabsorption Syndromes; Male; Nervous System Diseases; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Seven patients being treated for acute lymphoblastic leukaemia between March 1976 and March 1981, in accordance with Medical Research Council protocols, developed clinical malabsorption while on maintenance chemotherapy. All of them received weekly methotrexate and 6 of the 7 were given co-trimoxazole. Five patients had folate deficiency. Stopping the anti-leukaemic therapy led to a resolution of gastrointestinal symptoms. A combined effect of methotrexate and co-trimoxazole is postulated.

Topics: Adolescent; Anti-Infective Agents; Antineoplastic Agents; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Female; Humans; Infant; Jejunum; Leukemia, Lymphoid; Malabsorption Syndromes; Male; Methotrexate; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination