Metronidazole and risk of acute pancreatitis: a population-based case-control study.
BACKGROUND
Use of metronidazole has been suggested to be associated with an increased risk of acute pancreatitis in case reports.


OBJECTIVE
To examine this issue within a proper epidemiological design.


METHODS
We identified 3083 incident cases of acute pancreatitis from Hospital Discharge Registries in three Danish counties and 30 830 matched population controls. From prescription databases, we extracted information on use of metronidazole with or without concomitant use of proton-pump inhibitors and/or amoxicillin, macrolides or tetracycline.


RESULTS
Adjusted odds ratios for acute pancreatitis in study subjects who redeemed a prescription for metronidazole within 30, 31-180, or 181-365 days before hospitalization or index date among controls were 3.0 [95% confidence interval (CI): 1.4-6.6], 1.8 (95% CI: 1.2-2.9) and 1.1 (95% CI: 0.6-1.8), respectively. Among subjects with a concomitant prescription for proton-pump inhibitors and/or amoxicillin, macrolides or tetracycline within 30, 31-180, or 181-365 days before hospitalization, or index date among controls, adjusted odds ratios were 8.3 (95% CI: 2.6-26.4), 2.7 (95% CI: 1.4-5.5), and 1.7 (95% CI: 0.6-4.8), respectively.


CONCLUSIONS
Metronidazole may increase the risk of acute pancreatitis. However, the risk seems mainly to increase when metronidazole is used in combination with other drugs used for Helicobacter pylori eradication.
Nørgaard
M
M
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus C, Denmark. uxmeno@aas.nja.dk
Ratanajamit
C
C
Jacobsen
J
J
Skriver
M V
MV
Pedersen
L
L
Sørensen
H T
HT
D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D003718:Denmark / Q000453:epidemiology; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D010195:Pancreatitis / Q000139:chemically induced* / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D008795:Metronidazole