Possible azithromycin-associated hiccups.
OBJECTIVE
To report a case of persistent hiccups associated by azithromycin therapy.


METHODS
A 76-year-old man presented with persistent hiccups after beginning azithromycin for the treatment of pharyngitis. Hiccups were persistent and exhausting. Discontinuation of azithromycin and therapy with baclofen finally resolved hiccups. No organic cause of hiccups was identified despite extensive investigation.


CONCLUSIONS
Pharmacotherapeutic agents have been uncommonly associated with hiccups. Corticosteroids (dexamethasone and methylprednisolone), benzodiazepines (midazolam) and general anaesthesia have been the specific agents mentioned most frequently in the literature as being associated with the development of hiccups. Few cases of drug-induced hiccups have been reported related to macrolide antimicrobials. Using the Naranjo adverse effect reaction probability scale this event could be classified as possible (score 5 points), mostly because of the close temporal sequence, previous reports on this reaction with other macrolides and the absence of any alternative explanation for hiccups. Our hypothesis is that a vagal mechanism mediated by azithromycin could be the pathogenesis of hiccups in our patient.


CONCLUSIONS
Diagnosis of drug-induced hiccups is difficult and often achieved only by a process of elimination. However, macrolide antimicrobials have been reported to be associated with hiccups and vagal mechanism could explain the development of this side-effect.
Department of Internal Medicine, Infectious Diseases Division, Hospital of San Juan, Alicante, Spain. fjoverdiaz@coma.es
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Jover
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Cuadrado
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Merino
D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D017963:Azithromycin / Q000009:adverse effects* / Q000627:therapeutic use*; D006606:Hiccup / Q000139:chemically induced*; D006801:Humans; D008297:Male; D010612:Pharyngitis / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D017963:Azithromycin