Metronidazole and risk of acute pancreatitis: a population‐based case–control study

Abstract

SUMMARYBackground: Use of metronidazole has been suggested to be associated with an increased risk of acute pancreatitis in case reports. Aim: 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 met-

New advances in acute pancreatitis

“…Proton pump inhibitors and H2 blockers may increase the risk of AP, but these data are confounded because untreated GERD and gastritis may increase the risk of AP [13]. Interestingly, valproic acid may not be an independent risk factor for AP because the adjusted odds ratio for AP in current users of valproic acid is 2.6, similar to the odds ratio of other antiepileptics [14].…”

Increased risk of acute pancreatitis among tetracycline users in a Swedish population-based case–control study

“…To the best of our knowledge, no epidemiological study has previously analysed the association between tetracycline drugs and acute pancreatitis. However, a Danish population-based case–control study of metronidazole use and risk of acute pancreatitis observed a markedly increased risk when metronidazole was used in combination with proton pump inhibitors and/or amoxicillin, macrolides, or tetracycline compared with the use of metronidazole alone, but the specific OR for concomitant use of tetracycline was not reported 31. We saw no such effect of adjustment for metronidazole or proton pump inhibitor use (data not shown).…”

Acute Pancreatitis Induced by Methimazole Therapy

“…The effect of polypharmacy and combination drug therapy on the increased incidence of acute pancreatitis was highlighted in a case-control study from Denmark. One example given in that study described that the risk of developing acute pancreatitis from metronidazole was increased 8-fold if patients received metronidazole in combination with other drugs used to eradicate Helicobacter pylori , such as proton pump inhibitors and amoxicillin [9, 10]. …”