Carnitine deficiency induced by pivampicillin and pivmecillinam therapy.
Short-term administration of pivampicillin and pivmecillinam resulted in a reduction of serum carnitine concentration and an increase in excretion of acylcarnitine in urine. These changes persisted for more than ten days after cessation of therapy. In seven girls on long-term treatment with a mixture of pivampicillin and pivmecillinam the mean total serum carnitine concentration fell to 15% (7-27%) of pretreatment values. The acylcarnitine fraction was 11-57% of total carnitine, compared with less than 2% before treatment. Muscle carnitine concentrations in two girls treated with the antibiotics for 22 and 30 months were only 10% of the mean reference value. These concentrations in serum and muscle are in the range encountered in patients with carnitine deficiencies of other aetiologies in which life-threatening metabolic crises may arise. The risk of adverse effects from prodrugs that give rise to pivalic acid should be seriously considered, particularly in patients under metabolic stress.
Holme
E
E
Department of Clinical Chemistry, Gothenburg University, Sahlgren's Hospital, Sweden.
Greter
J
J
Jacobson
C E
CE
Lindstedt
S
S
Nordin
I
I
Kristiansson
B
B
Jodal
U
U
D000293:Adolescent; D000328:Adult; D000560:Amdinocillin / Q000009:adverse effects*; D000561:Amdinocillin Pivoxil / Q000008:administration & dosage / Q000009:adverse effects*; D000667:Ampicillin / Q000031:analogs & derivatives*; D002331:Carnitine / Q000032:analysis / Q000172:deficiency* / Q000652:urine; D002648:Child; D002675:Child, Preschool; D002849:Chromatography, Gas / Q000379:methods; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D013058:Mass Spectrometry / Q000379:methods; D009132:Muscles / Q000032:analysis; D010421:Pentanoic Acids / Q000378:metabolism; D010917:Pivampicillin / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors; D014552:Urinary Tract Infections / Q000097:blood / Q000188:drug therapy / Q000652:urine
D010421:Pentanoic Acids; D010917:Pivampicillin; D000561:Amdinocillin Pivoxil; D000667:Ampicillin; C005566:pivalic acid; D002331:Carnitine; D000560:Amdinocillin